Biennial report of the North Carolina State Board of Health

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Thirty-Sixth Biennial Report
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
JULY 1, 1954—JUNE 30, 1956
I
MEMBERS OF THE STATE BOARD OF HEALTH
Elected by the Medical Society of the State of North Carolina
G. Grady Dixon, M.D.,
Term expires 1959
John R. Bender, M.D.,
Term expires 1957
Ben J. Lawrence, M.D.,
Term expires 1957
G. Curtis Crump, M.D.,
Term expires 1959
Appointed by the Governor
A. C. Current, D.D.S.,
Term expires 1957
H. C. Lutz, Ph.G.,
Term expires 1959
Mrs. J. E. Latta,
Term expires 1957
John P. Henderson, Jr., M.D.,
Term expires 1959
* Lenox D. Baker, M.D.,
Term expires 1957
EXECUTIVE COMMITTEE
G. Grady Dixon, M.D., Chairman
Ben J. Lawrence, M.D., Vice President
John R. Bender, M.D.
J. \V. R. Norton, M.D., Secretary
EXECUTIVE STAFF AS OF JUNE 30, 1956
J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer
John H. Hamilton, M.D., Assistant Slate Health Officer and Director
Laboratory of Hygiene Division
Ernest A. Branch, D.D.S., Director Oral Hygiene Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
C. C. Applewhite, M.D., Director Local Health Division
A. H. Elliot, M.D., Director Personal Health Division
Fred T. Foard, M.D., Director Epidemiology Division
* Dr. Baker appointed to fill unexpired term of Dr. Hubert B. Haywood, who retired
January, 1956.
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LOCAL HEALTH OFFICERS IN
NORTH CAROLINA
N. C. State Board of Health, Local Health Division
Raleigh, N. C.
SEPTEMBER 28, 1956
DEPARTMENT
Madison
LETTER OF TRANSMITTAL
The Honorable Luther Hodges
Governor of North Carolina
The State Capitol
Raleigh, North Carolina
Dear Governor Hodges:
Pursuant to the provisions of Section 130-3, General Statutes of North
Carolina, I herewith submit to you, and through you, to the General
Assembly of North Carolina, the Biennial Report of the North Carolina
State Board of Health for the fiscal years of July 1, 1954-June 30, 1956.
Respectfully submitted
J. W. R. Norton, M.D.,
Secretary and State Health Officer
TABLE OF CONTENTS
Report of Secretary-Treasurer and State Health Officer 9
Chronic Diseases—A Joint Responsibility of
Private Practice and Public Health 41
State and Local Health Department Services in North Carolina 44
Central Administration 48
Personal Health Division 54
Local Health Division 68
Division of Epidemiology 02
Sanitary Engineering Division 110
State Laboratory of Hygiene 115
Division of Oral Hygiene 123
Report of Medico Legal Examinations Committee * • 127
REPORT OF THE SECRETARY-TREASURER
AND STATE HEALTH OFFICER
July 1, 1954—June 30, 1956
Abridged report of the activities of the State
Board of Health as recorded in the Minutes:
July 1, 1954. The first quarterly meeting of the North Carolina State
Board of Health for the biennium July 1, 1954-June 30, 1956, was held on
Thursday, July 1, 1954, at 10:30 a.m., in the auditorium of the State Labora-tory
of Hygiene Building, with President G. Grady Dixon, presiding. The
meeting was called to order by President Dixon.
Upon motion duly made and seconded, the Minutes of the May 5 meeting
were approved, without being read, since all members had previously re-ceived
a copy.
Dr. Hamilton made a further progress report regarding the Medical
Library, as to the lighting system, acoustics, painting and other repairs,
including a request to the Board of Buildings and Grounds for the privilege
of having the Library air-conditioned. This request has not been granted
so far. Dr. Hamilton also stated that Mr. John M. Gibson had been elected
Librarian, effective as of June 1, 1954. He comes from the Alabama Health
Department and was born at Gibson, North Carolina.
Dr. Hamilton and Mr. Jarrett discussed further progress on moving into
the new Cooper Memorial Health Building. Mr. Jarrett reported on plans,
length of time to move, etc., which he had discussed with the Transfer
Company. Dr. Hamilton said that the final inspection of the Building was
held on June 22 by the Board of Buildings and Grounds, architects, budget
engineers and others, and that the Building was accepted with the excep-tion
of the basement, the pent house and the heating tunnel and had now
been turned over to the Board of Buildings and Grounds which Board could
now have the telephones installed.
Secretary Norton reported on the N. C. Public Health Association meet-ing
which is to be held in Raleigh, September 23-25, 1954. The Board
discussed plans for the dedication of the Cooper Memorial Health Building,
time and place of a regular Board meeting at the time of the NCPHA
meeting, etc., but no decisions were made. The Board asked the Executive
Committee to work out, with the NCPHA, a definite program and advise
the members later.
Dr. C. C. Applewhite, Director, Local Health Division, was present and
discussed a suggested amendment to the Policies of the North Carolina
State Board of Health for Allocation of State Aid Funds to Local Health
Units, effective July 1, 1954. The additional paragraph related to the
employment of a part-time Health Officer, etc. It was moved by Mr. Lutz,
seconded by Mrs. Latta and unanimously carried, that the following para-graph
be inserted after the second paragraph in the policies governing
allocation of State Aid Funds to local health units:
10 Thirty-Sixth Biennial Report
"When any local health department is temporarily without the services
of a full-time health officer and it becomes necessary to employ a part-time
health officer, pending the selection of a full-time health officer meeting
Merit System qualifications, the salary of the part-time health officer shall
be determined on the percentage of full time spent in activities of the
health department. The maximum salary that may be paid the part-time
health officer shall not exceed one-half of the salary of a full-time health
officer having the same Merit System classification."
In a further discussion regarding bulk milk diespensers, Mr. Jarrett
presented some revised regulations governing the sanitation of restaurants,
summer camps and private institutions which were effected by the use of
the approved bulk milk dispensers. On motion of Dr. Lawrence, seconded
by Mrs. Latta, revisions to Section 6, Item 17 of the Law, Rules and Regu-lations
and Code Governing the Sanitation of Restaurants and Other Food
Handling Establishments, Section 7, Item 10 of the Law, Rules and Regu-lations
Governing the Sanitation of Summer Camps, Section 6, Item 16,
of the Law, Rules and Regulations and Code Governing the Sanitation of
Private Hospitals, Sanatoriums, Sanitariums and Education Institutions
are hereby amended in accordance with the action taken by the Board of
Health at its meeting in Pinehurst, N. C, May 5, 1954, which permitted
the use of approved bulk milk dispensers in those places desiring to use
them. Motion carried. (Copy of amendments filed in Minute Book)
Mr. Jarrett presented a request concerning the extension of the boundary
lines of the Roanoke Rapids Sanitary District and also the Town of Roanoke
Rapids. He stated that all documents had been carefully examined and
checked and that proper procedures had been followed in accordance with
requirements of the General Statutes for the extension of sanitary district
boundaries, and that he recommended favorable action by the Board. On
motion of Dr. Lawrence, seconded by Mr. Lutz, the resolutions approving
the extension of the boundary lines of the Roanoke Rapids Sanitary Dis-trict
in Halifax County and also the Town of Roanoke Rapids, were unani-mously
approved. (Copy filed in Minute Book)
Dr. Fred T. Foard, Director of the Division of Epidemiology gave a
very interesting and informative talk on the overall activities and accom-plishments
of the Division. He then introduced the seven Section Chiefs
in the Division, each of which has specific functions to perform in relation
to the control of disease or injury. These sections are: (1) Public Health
Statistics; (2) Communicable Disease Control; (3) Tuberculosis Control;
(4) Veterinary Public Health; (5) Industrial Hygiene; (6) Venereal Disease
Control; (7) Accident Prevention. In addition, the Division is conducting
a temporary study of crash automobile accidents in cooperation with the
State Motor Vehicles Department and sponsored by the Cornell University
Medical College and the Kellogg Foundation. Also, the Division is charged
with the collection of reports of narcotic addicts in North Carolina. Each
Section Chief presented a brief but concise report of the work in his re-spective
Section.
On the use of gamma globulin as polio preventive, Dr. Hamilton stated
that he had received a shipment of 95,000 cc. of gamma globulin for dis-tribution,
on request of Dr. Foard, as Director of Epidemiology.
North Carolina Board of Health 11
Dr. Foard stated that he is attempting- to recommend distribution of
gamma globulin to conform with recommendations of the National Foun-dation
for Infantile Paralysis, Inc.—that is, for use against polio only in
groups larger than single family groups. He stated that one shipment has
been sent out this year to Rockingham for use in treating neighborhood
contacts to an active case of polio, the diagnosis of which has been con-firmed
by staff at Duke University Hospital.
Miss Mae Reynolds, Budget Officer, presented and discussed briefly the
budgets for 1954-1955. Dr. Norton expressed appreciation to Miss Reynolds
for the excellent work she has done over the years and is doing as Budget
Officer.
Dr. Norton announced that he would be glad to have each one visit the
new Health Building offices and Library before leaving.
September 24, 1954.
The State Board of Health met in quarterly session in the Board Room,
in the Cooper Memorial Health Building, Friday afternoon, September 24
at 2:00 o'clock, Dr. G. Grady Dixon of Ayden, President, presiding. This
was the first regular meeting of the Board in the Cooper Memorial Health
Building which is the first State Health Office Building designed and con-structed
specifically for public health work in North Carolina.
Following the call to order, the Minutes of the previous session, held in
Raleigh, July 1, 1954, which had been circulated among the members, were
unanimously approved.
Dr. J. W. R. Norton, Secretary, then presented a progress report on
bulk milk dispensers. It was pointed out that the use of such dispensers
was approved by the State Board of Health, in session at Pinehurst, May 5,
1954. The State Board of Agriculture, in August, adopted a set of regula-tions
concerning the use of bulk milk dispensers which provided that the
amount dispensed should be no less than 8 fluid ounces, and that no milk
dispenser should be offered for sale or put into use in this State which was
not so built as to make possible the attachment of a measuring device.
Such a provision was not included in the regulations adopted by the State
Board of Health. The Board, advised of the regulations adopted by the
State Board of Agriculture, decided that further action on its part was
unnecessary at this time. Mr. John Andrews, Chief of the Sanitation Sec-tion,
served on a committee advising with the Board of Agriculture in
drawing up its regulations.
The Board then took up the question of issuing an order for the town of
Pembroke to construct a sewage treatment plant. Mr. William McKimmon
explained the matter briefly and concisely. Upon motion of Dr. Lawrence,
seconded by Dr. Henderson, a resolution was adopted ordering the town of
Pembroke to construct a new sewage treatment plant and necessary appur-tenances.
(Copy of Order filed in Minute Book)
The Board heard a report on the revised Communicable Disease Regula-tion
40, relating to Psittacosis, copies of which had been sent to each Board
member several days previously. The matter was presented by Dr. Fred T.
Foard and explained by Dr. Martin P. Hines, Chief of the Veterinary
Public Health section of the Division of Epidemiology. He advised the
12 Thirty-Sixth Biennial Report
Board that, although there is no provision for paying an indemnity to
merchants whose birds are confiscated and killed when suspected of having
psittacosis, Mr. Ralph Moody, Assistant Attorney General, had assured
him that the department of the Attorney General would stand back of the
State Board of Health in the enforcement of the amended regulation for
the control of psittacosis. (Copy of Revision of Communicable Disease
Regulation 40 Relating to Psittacosis filed in Minute Book)
It was pointed out that, while it was the intention of the General
Assembly that the new Health Building should be named the George
Marion Cooper Memorial Health Building, Chapter 76 authorized the State
Board of Health to do so,—making ratification necessary on the part of the
Board. Upon motion of Dr. Lawrence, seconded by Dr. Henderson, the
Board unanimously passed the following resolution:
"That, in conformity with Chapter 76 of the 1951 Session Laws, ratified
on the 20th day of February, 1951, we do hereby name the new Health
Building on North McDowell Street, the George Marion Cooper Memorial
Health Building."
Following the above order of business, Dr. E. A. Branch, Director of the
Oral Hygiene Division, appeared before the Board with visual demonstra-tions
of the objectives and accomplishments of his Division. While Dr.
Branch's appearance called for no official action on the part of the Board,
those present unanimously expressed their approval of his efforts and
their appreciation of the work that he and his staff have accomplished in
behalf of the school children of North Carolina. Dr. Branch emphasized
the difficulty of obtaining adequate personnel for the administration of
the State's Oral Hygiene program. While there seemed no answer, at
present, to this dilemma, the hope was expressed that, through a continu-ation
of effort, including education, young dentists yet may be prevailed
upon to fill the vacancies in which they can render great service to the
children of North Carolina.
The Board adjourned to attend a reception at the Executive Mansion,
complimentary to the members of the North Carolina Public Health Asso-ciation,
assembled in Raleigh for their 43rd annual meeting.
January 25, 1955.
The North Carolina State Board of Health met in regular quarterly
session, Tuesday, January 25, 1955, at 10:00 a.m. in the Board Room of the
Cooper Memorial Health Building, with President Dixon presiding. The
meeting was called to order by President Dixon.
Minutes of the Board meeting held on September 24, 1954, were approved
as circulated to the members of the Board by the Secretary.
Secretary Norton gave a bi'ief report on the conference of local health
officers held on January 18th. He stated that the attendance was good and
a number of subjects were discussed informally pertaining to matters of
current interest to the health officers regarding the budget for the next
biennium, proposed legislation, and the polio vaccine (Salk). Also, the
Secretary made a report on the Cancer Survey and Dr. Hamilton and Mr.
John M. Gibson gave a progress report on the Library. Honorable Luther
H. Hodges, Governor of North Carolina, appeared before the local health
North Carolina Board of Health 13
officers at 2:30 at their afternoon session, and gave them a very interesting
and stimulating talk on public health, praising the work they were doing
and complimenting them on the distinctive and worthwhile service being
accomplished in the State.
At this point, Governor Hodges honored the Board of Health with a visit.
He was presented by President Dixon, who expressed his appreciation that
the Governor had accepted Secretary Norton's invitation to be present at
the Board meeting on this occasion. The Governor stated that he was very
happy to be present, that he was trying to see as many of the important
boards as possible, and that he certainly would include the Board of Health
of North Carolina as one of these; that he has known of the work of the
State Board of Health since he was a young man. "I think," he continued,
"you are the kind of dedicated people who do a great humanitarian job."
He repeated a statement made to the local health officers, when he declared
that if each would spend the state money as though he was paying for the
job himself, he would get an additional thrill at the end of each day's work.
The Governor discussed the current state budget and said he recently
startled a group by declaring that North Carolina, within a few years,
will be a billion dollar state when funds from all sources are counted.
"Health and education," he stated, "must move with our population growth.
In these fields, we must recognize and meet the problems of our new
children. As we move forward in big figures, we must also move along in
our services to the people." He said, in conclusion: "I bring you greetings
and thank you and the others, in the name of North Carolina, for the
services rendered." Dr. Dixon thanked the Governor for his visit.
At the conclusion of Governor Hodges' address, it was pointed out that
this was the first time within the recollection of anyone present that a
Governor had attended a meeting of the Board. In view of this, Dr. Ben J.
Lawrence moved that the Board adopt a resolution, expressing appreciation
not only of Governor Hodges' visit, but of his remarks, in which he ex-pressed
appreciation for public health work in North Carolina and called
for a vededication to the service of humanity, and that a copy be sent to
the Governor and also spread on the Minutes of the Board. Motion was
seconded by Dr. Crump and carried unanimously.
Dr. Charles M. Cameron of the Epidemiology Division, made photographs
of the Board with the Governor. Dr. John Bender asked that a copy be
sent to each member and also that the Board go on record as expressing
appreciation for Dr. Cameron's services.
Dr. Dixon mentioned the regrettable accident of Miss Mae Reynolds,
the budget officer, who had the misfortune of falling on the snow anil frac-turing
a hip. A note expressing the Board's deep appreciation for her
faithful services and wishing for her a speedy and uneventful recovery
was signed by each and forwarded to her,—in addition to flowers.
Dr. B. M. Drake of the Local Health Division, in which the School Health
Coordinating Service is lodged, had prepared a brief report on this joint
Service with the Education Department. There were discussions by Doctors
Hamilton, Applewhite and Branch, but no action taken. Secretary Norton
stated that the School Health Work was also being studied by an Advisory
14 Thirty-Sixth Biennial Report
Committee from the Medical Society and the State Dental Society and
that they may have a report to make in the near future.
Dr. Hamilton gave a report on the progress of the Medical Examiner
Bill which is to be introduced in the General Assembly, a copy of which
has been sent to each member of the Board, and to be known as A BILL
TO BE ENTITLED AN ACT TO REVISE THE LAWS OF NORTH
CAROLINA WITH RESPECT TO POSTMORTEM MEDICOLEGAL EX-AMINATIONS.
Dr. Cameron brought greetings from Dr. Foard, the Director of the
Epidemiology Division, who was delayed. He also discussed tentative
items of proposed legislation which might be brought up before the General
Assembly, but on which no immediate action was required by the Board,
namely: (a) the disposal of abandoned ice boxes and refrigerators; (b)
amendments to existing vital statistics laws, and (c) revision in the State's
enabling act relative to the rabies program.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was
present and discussed a petition which would create a sanitary district in
McDowell County. He stated that various transactions and documents had
been examined by his office, and, in their opinion, were in order. He, there-fore,
recommended that the Board create the proposed district. Dr. Bender
moved that the resolution creating the District to be known as the East
Marion Sanitary District, be adopted. Motion was seconded by Dr. Crump
and unanimously carried. (Copy of resolution filed in Minute Book)
Mr. Jarrett also discussed an order for Farmville, to install adequate
sewage treatment facilities and sewer extensions. He recommended favor'
able action by the Board on this resolution, stating that all documents and
transactions had been examined and found in order by his office. On motion
of Dr. Current, seconded by Dr. Henderson, the resolution ordering the
Town of Farmville to make necessary sewerage improvements was carried.
(Copy of resolution filed in Minute Book)
A resolution ordering the Town of Woodland to install an adequate
sewage collecting system and sewage treatment facilities was presented
and discussed by Mr. Jarrett. He also recommended favorable action by
the Board on this resolution. On motion of Dr. Current, seconded by Dr.
Lawrence, the resolution ordering the Town of Woodland to make necessary
sewerage improvements, was carried. (Copy of resolution filed in Minute
Book)
Mr. Jarrett again discussed the bulk milk dispenser regulations and
presented a revision, or insert, to Item 17 of Restaurant Sanitation Regu-lations
as follows:
"; provided further, that in the case of restaurants and hotels having
several banquet halls and dining rooms served from a central kitchen, if
careful investigation proves it impractical to locate the milk dispenser in a
dining room because of established food checking and serving routines, the
milk dispenser may be installed in the food serving area of the kitchen in a
location specifically approved by the local health officer and the label infor-mation
required by this item shall be shown prominently on the menu cards
instead of on the milk dispenser cabinet."
North Carolina Board of Health 15
On motion of Dr. Current, seconded by Dr. Bender, this amendment was
approved.
Secretary Norton discussed possible revision of the law to change the
title of Secretary and State Health Officer. It was the consensus that this
matter should be discussed with the Attorney General as to how far-reaching
this change would be and what effect on regulations and what
change it would make in this Board, if any.
The meeting was declared adjourned at 1:10 p.m. to meet at 2:00 p.m.
in the Revenue Building to appear at the hearing before the Joint Appro-priations
Committee.
May 4, 1955. The State Board of Health met in the Dutch Room of the
Carolina Hotel in Pinehurst, Wednesday, May 4, at 1:30 p.m., Dr. G. Grady
Dixon, the President, presiding.
The meeting was called to order. On motion duly made and seconded,
the minutes of the January 25, 1955 Board meeting were approved without
being read since members had previously received copies.
The first matter taken up was that concerning pending actions in the
field of Sanitary Engineering, with an explanation of each by Mr. J. M.
Jarrett, Director of the Sanitary Engineering Division. The first item was
a recommendation for the creation of what is known as the Rutherford
College Sanitary District. A delegation from the district was present to
hear the discussion, if any, pertaining to this matter. After the Board had
heard Mr. Jarrett's explanation, Dr. Current moved that the district be
created and his motion was seconded by Dr. Haywood. Affirmative action
was unanimous. (Copy of resolution filed in Minute Book)
Mr. Jarrett next presented a proposed ordinance which would, in effect,
permit fishing in Lake Benson in Raleigh, along with Lakes Raleigh and
Johnson, in the City's water supply system. On motion of Dr. Haywood,
seconded by Dr. Henderson, this was approved, as requested by the gov-erning
body of the City of Raleigh. (Copy of Resolution filed in Minute
Book)
Action on a third item, namely, a revision of regulations regarding sub-mission
of plans for water and sewerage systems, was deferred until a
subsequent meeting, at which time the matter will be explained by Mr.
Jarrett, who stated that some of the present regulations are outmoded.
Dr. Norton called the Board's attention to the manner in which money is
raised for agencies and suggested that Board members be giving this
matter attention and consideration and discussion at a future meeting in
regard to such funds. Dr. Norton made particular reference to percentages
sent out of the State and amounts spent within North Carolina and by the
local communities. Upon motion of Dr. Crump, seconded by Dr. Current,
it was agreed that the matter of fund raising and national, state and local
sharing be taken up and given thorough consideration at an early meeting
of the Board.
Dr. Norton then called attention to the method in which complaints
reaching his office are handled. He gave one specific example and informed
the Board that every complaint coming to his desk was investigated and
that the complainant was given the results of findings. Some complaints,
16 Thirty-Sixth Biennial Report
he said, are justified and some are not, but this, in his opinion, does not
relieve his office of its responsibility to look into all matters pertaining to
health in North Carolina.
The next item on the agenda involved a report by Dr. Norton on pending
State and national legislation affecting Public Health. He called attention
to the fact that he shared the view of leading health officials—such as Dr.
Hilleboe of New York— that the distribution of the Salk vaccine should be
on a voluntary control basis. He said that, in his opinion, controls involving
legislation will cause confusion and delay, while he thought that voluntary
control would assure better results. He pointed out the fact that, at a
Conjoint Session of the Board and the State Medical Society, a few minutes
prior to the Board meeting, a resolution favoring voluntary, rather than
stringent governmental control, was adopted.
Dr. Norton called the Board's attention to a telephone message, in which
Mr. David S. Coltrane had informed him of a proposed change in the
$550,000 School Health Appropriation Bill substituting the word "profes-sional"
for "medical and dental." He said that action, in his opinion, would
let down the bars for practitioners of various kinds outside the realm of
medicine and dentistry. He stated that without the retention of the word
"medicine" it would be best to return to the single line item as before.
Upon motion of Dr. Current, seconded by Dr. Crump, the Board went on
record as insisting upon the retention of the word "medical" in the appro-priations
measure above referred to.
The next item on the agenda called for discussion with a view to clarify-ing
policies of the North Carolina State Board of Health for the allocation
of funds to local health departments. Dr. C. C. Applewhite stated that under
the present system it is often impossible to employ competent personnel.
He stated that he wished to bring the matter to the Board's attention at
this time because local budgets now are being prepared. Dr. Current moved,
Dr. Crump seconded, and the Board passed the amendment.
Dr. Lawrence proposed that at a later meeting when the matter could
be handled in an unhurried way there should be thought, discussion, and
appropriate action on outside influences in the employment of personnel.
It was so agreed and Mrs. Kneedler will be asked to be present for that
meeting.
Dr. Norton called attention to the fact that his term as State Health
Officer and that of Dr. John H. Hamilton, as Assistant State Health Officer,
will expire this year, but indicated he did not think the Board had time to
go into this matter at this limited session, which had to be concluded at
2:15 p.m. President Dixon stated that the re-election of Dr. Norton and
Dr. Hamilton was merely a formality and could be disposed of without loss
of time. Dr. Haywood moved the re-election of Dr. Norton and Dr. Hamil-ton,
seconded by Dr. Current. Dr. Dixon made the observation that no
motion really was necessary, as the Board was unanimous in this matter.
Dr. Norton and Dr. Hamilton were re-elected for four year terms beginning
July 1, 1955, by acclamation.
The President is to write a letter to Governor Hodges notifying him
officially of the Board's action. (Governor Hodges was officially notified on
North Carolina Board of Health 17
May G and his letter of confirmation was duly received on May 11, 1955).
June 30, 1955. The North Carolina State Board of Health met in regular
quarterly session, Thursday, June 30, 1955. The Board went first to the
office of Governor Luther H. Hodges, in the Capitol, where at 9:30 a.m.,
Associate Justice R. Hunt Parker, of the North Cai'olina Supreme Court,
administered the Oaths of Office to the following, for four-year terms,
expiring May, 1959:
Governor Hodges' Appointees: H. C. Lutz, Ph.G., Hickory — (Re-appointed)
; John P. Henderson, Jr., M.D., Sneads Ferry — (Re-appointed).
Elected by the North Carolina Medical Society: G. Grady Dixon, M.D.,
Ayden — (Re-elected); G. Curtis Crump, M.D., Asheville — (Re-elected).
Following the exercises in the Governor's Office, the Board went into
regular session in the Board Room in the Cooper Memorial Health Building.
The meeting was called to order by Vice-President, Dr. Hubert B. Haywood.
On motion of Dr. Current, seconded by several members, Dr. Dixon was
unanimously re-elected to serve another term as President of the State
Board of Health, and he took the chair.
Minutes of the Board meeting held on May 4, 1955, were approved,
without being read, as copies had been circulated to each member.
Secretary Norton gave an informative report with regard to national
health programs for which there is solicitation in the State in relation to
percentage of collections retained and sent out of the State. He pointed out
the percentages governing the division of funds raised in campaigns in
North Carolina by the twelve State branches of large national health
organizations operating in this State such as: the North Carolina Division,
American Cancer Society; North Carolina Heart Association; North Caro-lina
Society for Crippled Children and Adults; North Carolina Tuberculosis
Association; National Federation for Infantile Paralysis; Muscular Dys-trophy
Association of America; United Cerebral Palsy Association of
North Carolina; National Multiple Sclerosis Society; Arthritis and Rheu-matism
Foundation; National Association for Mental Health; National
Jewish Hospital at Denver; Sister Elizabeth Kenny Foundation. There was
no action taken but it was suggested that a copy of this chart be furnished
each Board member for study and information. Several expressed an opin-ion
that too large an amount goes to national organizations and very little
is retained in the State and particularly locally.
Dr. C. C. Applewhite, Director of the Local Health Division, and Mis.
.Mary King Kneedler, Chief, Public Health Nursing Section, were present.
Dr. Applewhite made an informative report regarding possible outside
influences in the employment of personnel. In the discussion. Dr. Apple-white
took the position that since the Board of Health is under the Merit
System and State Personnel Department, it has to follow the rules and
regulations and policies of these official agencies, and that even good genera]
rules may, in extremely rare cases, become an individual hardship.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was
present and presented a request for a Sanitary District to be created and
to be known as the "Enon Sanitary District" in Burke County. Mr. Jarrett
stated that all documents and transactions had been carefully examined
18 Thirty-Sixth Biennial Report
by his Division, and were in order for the creation of the District. At this
point, Mr. Jarrett introduced Mr. W. T. Joyner, Jr., Attorney for the
Southern Railway, who had requested an opportunity to appear before
the Board. Mr. Joyner objected to the Sanitary District including the right-of-
way of the Southern Railway. The railroad has no objections to being
included in the District, provided its lines were not included simply for tax
purposes, he said. After discussion by Mr. Joyner and members of the
Board, it was decided that action regarding the formation of the District
be deferred until the boundary line could be established. Since it was
brought out during the discussion that approximately thirty-three houses
outside of the proposed District were to be served by the Sanitary District,
the question was raised as to whether or not it might be best to include
them within the District at this time.
Mr. Jarrett also presented a request from the Town of Claremont, North
Carolina, asking that the State Board of Health issue an Order making it
mandatory that the Town install a sewerage system and sewage treatment
plant. He stated that all documents had been carefully examined and
checked and that proper procedures had been followed in accordance with
the requirements of the General Statutes. On motion of Dr. Current, sec-onded
by Mrs. Latta, the Order for the Town of Claremont to install
adequate and necessary treatment facilities, was unanimously carried.
Mr. Jarrett then reported informatively on the use of iodophors for the
bactericidal treatment of milk and food utensils and equipment. It was
brought out that if approval was given, our present sanitary regulations
would have to be amended. After much discussion, the approval of the use
of iodophors was deferred.
Dr. A. H. Elliot, Director of the Personal Health Division, appeared
before the Board, on invitation from Secretary Norton, to explain the
result of a conference with regard to re-licensing the Muscular Dystrophy
Association of America. The problem involved was one of complaint within
the State that local funds appeared not to be readily available for muscular
dystrophy patients in localities in which funds had been raised. Dr. Ellen
Winston's office desires the support of the State Board of Health in with-holding
any re-licensing until she has assurance that funds would be dis-pensed
within the State, according to national regulations. No action was
taken, as this report was for the Board's information.
Dr. John H. Hamilton, Assistant State Health Officer, and Dr. Fred T.
Foard, Director of the Division of Epidemiology, both just back from a
conference in Washington, reported on proposed plans for the distribution
of Salk polio vaccine, after the contractual obligations of the National
Foundation for Infantile Paralysis have been fulfilled. There was a general
and informal discussion of various angles of the vaccine situation, but no
action was taken.
Secretary Norton reported to the Board on his trip to the Eighth World
Health Assembly, in Mexico City, May 10-28, 1955, which he said was most
informative and stimulating.
September 23, 1955. A meeting of the North Carolina State Board of
Health was held at the Robert E. Lee Hotel, Winston-Salem, Friday, Sep-
North Carolina Board of Health 19
tcmber 23, 1955, 2:30-5:00 p.m., at the time and place of meeting of the
44th Annual Session of the North Carolina Public Health Association.
Board members and their wives (or husband) were invited guests of the
Association at the annual banquet and dance on Friday evening.
The Board meeting was called to order by President Dixon. The minutes
of the Board meeting held on June 30, 1955, were approved without being
read since all members had previously received a copy.
Secretary Norton made a progress report and presented a chart or table
showing the amount of funds raised and available to North Carolina by
certain national health organizations soliciting funds in the State. There
was much discussion on the subject and it was the consensus that a further
study should be made of these funds; that Dr. Norton provide the same
information to the Executive Council of the State Medical Society on
Sunday, September 25th, and also to secure further information and a
breakdown of the use of the funds from the State Welfare Department
for overhead, and what percentages are actually used for protective service.
Dr. Eugene A. Gillis, Regional Director, Department of HEW, Public
Health Service, Region III, Washington, D. C. was present. He was called
on from time to time to give information from the Public Health Service's
viewpoint.
Dr. Fred T. Foard, Director of the Division of Epidemiology, was present
and presented a progress report relative to poliomyelitis vaccine. He dis-cussed,
in detail, information as to the apportionment of vaccine for public
health agencies, the administration of the vaccine, etc., and stated that
"all local health departments will be inquired under provision of the Federal
law to administer vaccine in clinics free of charge, without a "means test,"
and no child will be refused vaccine by local health departments." Also,
carefully prepared charts, questions and answers giving information and
procedures regarding poliomyelitis vaccine had been prepared and was
presented to each Board member. There was much discussion of the State
plan for distributing and administering the vaccine but no action was taken
by the Board for changing the plan as submitted to and approved
by the U. S. Public Health Service.
Dr. John H. Hamilton, Assistant State Health Officer, was present and
discussed progress made on the recodification of public health laws and
regulations of the State Board of Health which are being rewritten and
revised to delete obsolete provisions and eliminate confusion. A study
of the present laws and regulations was started about six months ago by
the Institute of Government at Chapel Hill. Preliminary drafts of the
revised code will be prepared and a progress report made to the Board
later. After the adopted revisions have been approved by the Board, the
recommendations will be presented to the 1957 General Assembly. On
motion of Dr. Crump, seconded by Dr. Current, the following terminology
was suggested to be used:
(a) That the term "Board of Health" refer to the membership of the
Board.
(b) That term "Department of Health" or "Health Department" refer
to the administrative offices of the Board.
20 Thirty-Sixth Biennial Report
(c) That the term "Commissioner of Health" or "Health Commissioner"
be used instead of the present "Secretary-Treasurer and State
Health Officer."
(d) That the title of Assistant State Health Officer be changed to
"Deputy Commissioner of Health" or "Deputy Health Commissioner."
(e) That the Bureau of Vital Statistics be changed to "Vital Statistics
Office."
Motion carried unanimously.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, dis-cussed
further the Enon Sanitary District in Burke County which was
before the Board at its meeting on June 30th. In presenting the resolution
creating the Enon Sanitary District, Mr. Jarrett explained the corrections
which had been made in the boundaries of the district as originally pro-posed
which allowed for the inclusion of additional homes and also reduced
somewhat the total area involved, and recommended that the district be
created. Dr. Crump moved that the resolution creating the Enon Sanitary
Latta and unanimously carried. (Copy of resolution filed in Minute Book)
District in Burke County as revised be adopted. Motion seconded by Mrs.
Mr. Jarrett again discussed the question of acceptance of iodophores as
bactericidal agents for use in restaurants and dairies, and after further
study, he recommended the approval of the use of iodophores. Dr. Current
moved that the State Board of Health accept iodophores as a bactericidal
agent. Motion seconded by Dr. Crump, and carried.
Mr. Jarrett also discussed the construction of a raw water reservoir
as a standby storage for the Town of Reidsville. He presented a description
of the proposed reservoir site and also discussed the problem of stock
watering by the property owners. Mr. Jarrett stated that special in-vestigations
had been made of this problem and he recommended that the
watershed regulations for the protection of filtered surface water supplies
be amended to read as follows:
Section 5 of Watershed Regulations For the Protection of Filtered
Surface Water Supplies—"The habitual watering, washing, or wallowing
of any horses, mules, cattle, hogs, sheep, goats or any large animals shall
not be permitted in or along the margin of any water supply reservoir,
pond or lake; except, in cases where very large volumes of water are in-volved
and the State Board of Health determines, after a thorough investi-gation,
that the quality of the water, in the opinion of the Board, will
not be adversely affected so as to render it unsatisfactory for use as a
public water supply. The habitual washing or wallowing of any horses,
mules, cattle, hogs, sheep, goats or any large animals shall not be per-mitted
on unimpounded streams which are tributary to the public water
supply within a distance of 5 miles above the waterworks intake. The
above shall not prohibit the watering of domestic animals from tributary
streams on farms which may be located on the watershed." On motion of
Dr. Current, seconded by Dr. Bender, the above amendment to Section 5
of the watershed regulations for the protection of filtered surface water
supplies was unanimously adopted.
North Carolina Board of Health 21
Mr. Jarrett then presented and discussed the revised regulations govern-ing
the sanitation of restaurants and other foodhandling establishments
which had been circulated to the Board members for information and
study. He stated that these revisions became necessary because of changes
in the hotel and cafe laws made by the 1955 General Assmbly. After dis-cussion,
on motion of Dr. Current, seconded by Dr. Crump, the revised
regulations governing the sanitation of restaurants and other foodhandling
establishments, as amended, were adopted unanimously. (Copy filed in
Minute Book)
Secretary Norton reported a number of items of interest to the Board
members such as the efficiency of self-operated elevators which are now
being used in the building and of the damage which has been done to the
building by the hurricanes. Air conditioning of the building was also dis-cussed,
and on motion of Dr. Crump, seconded by Dr. Henderson, it was
suggested that a letter be written to Mr. George B. Cherry, Superintendent
of Buildings and Grounds, urging that air conditioning be installed just as
soon as practical. Motion unanimously carried.
Also, in making his report, Dr. Norton told the Board about losing
key employees, secretaries and clerks due to inability or delay in actions
by the State Personnel Department. After discussion, it was the consensus
that Secretary Norton draft a letter to the Governor for signature by Dr.
Dixon, as President of the Board, apprising him of the situation that has
come up in being unable to employ or reclassify qualified personnel be-cause
of obstruction by the State Personnel Department.
January 12, 1956. A regular quarterly meeting of the North Carolina
State Board of Health was held on Thursday, January 12, 1956, 10:00—
12:00 noon and 1:00 p.m.—3:30 p.m., in the Board Room, Cooper Memorial
Health Building, with President G. Grady Dixon, presiding.
Dr. Crump and Dr. Henderson notified Dr. Norton by telegrams that it
would be impossible for them to be present.
The meeting was called to order by the President, Dr. Dixon.
On Motion of Dr. Current, seconded by Dr. Haywood, the minutes of
the meeting held on September 23, 1955, were approved without being
read since all members had previously received a copy.
Dr. Norton reported on the Cornell Crash Injury study. He said the
study has progressed to the point that the Ford and Chrysler motor com-panies
have given $200,000 each for its continuation which is under the
general supervision of Cornell University. The approval of the Executive
Council of the Medical Society of the State of North Carolina has been
given for its continuation for the next two years. The principal results
of the study have been improvement in the type of steering wheel, so
that the steering post does not crash into the chest; locking doors so that
the doors will not fly open; padding for the instrument panel and visors,
and shatter-proof rear view mirrors. The material in the padding is a
material that absorbs shock about five times as well as foam rubber. North
Carolina was the pioneer State, and has been given recognition in the
reports on the study. A representative from Cornell, at a meeting with
22 Thirty-Sixth Biennial Report
Dr. Norton, agreed to provide reimbursement for one additional person
(clerk) in Vital Statistics and postage and materials of about $500.00.
Dr. Norton recommended that Board approval be given to continuing
the study for two years. Dr. Lawrence moved, seconded by Mr. Lutz, that
the Board approve continuation of the Cornell Crash Injury study for a
period of two years. Passage was unanimous.
Mrs. Isabelle R. Henderson, Chief of the Personnel Section, made a
report on the major personnel problems of the State Board of Health,
including those not solved satisfactorily by the State Personnel Depart-ment,
dating back to June, 1952; appeals to the State Personnel Council;
separations for better pay with other governmental agencies, and vacant
positions to be filled in the State Board of Health as of January 12, 1956.
Mrs. Henderson answered several questions asked by members of the Board.
Dr. Dixon recognized Dr. James P. Rousseau of Winston-Salem, Presi-dent,
and Mr. James T. Barnes, Executive Secretary of the State Medical
Society, inviting them to join in any of the discussions.
Dr. Fred T. Foard, Director of the Division of Epidemiology, made a
report on the distribution of the Salk polio vaccine and gave each Board
member copies of recent correspondence. There are 160,251 ccs. of vaccine
in the 70% allocation on hand at the manufacturers, which have not been
distributed Dr. Foard said. The larger health departments do not have
enough to inaugurate mass programs and are, therefore, giving it only at
health centers. Dr. Foard has asked every county not putting on a mass
program to make available any vaccine they cannot use, to other counties.
This is being done, he reported, and the demand is greater than the supply
in the 30% allocation. There are 900,000 children in the State eligible for
the vaccine and only 490,287 ccs. have been released, according to informa-tion
in hand. Three doses are necessary for each child. 187,125 ccs. have
been reported as sold to private physicians.
Dr. Rousseau said he felt that there is a great lack of demand for vac-cine,
due to absence of proper educational programs to the public; and
the unused vaccine in private channels, he feels, would be used, if an
educational program were promoted. Such a program has been started
and is on the radio and television, telling the people what the health
officers and medical profession feel about the value of vaccine and why
they should have their children immunized now before polio season comes.
This should increase the demand for vaccine. "If the health departments
run a shortage, I think the Medical Society is perfectly willing for them
to buy the extra amount that they need. My personal feeling is that the
vaccine should be distributed over the State as originally outlined—30-70
percent—but exceptions should be made," Dr. Rousseau said. A re-edu-cational
program is needed, because the first great enthusiasm was killed.
Dr. Norton stated that the State Board of Health has no authority
from either the Board or from the Governor's Advisory Committee to
purchase vaccine released through commercial channels at this time.
Dr. Foard suggested that the ratio be changed to 50-50.
Dr. Current made the point that any citizen in North Carolina can go
to the Public Health Department for any kind of immunization, if he so
North Carolina Board of Health 23
desires, and we should work as rapidly as we can toward bringing polio
vaccine into the same category as other immunizing agents.
Dr. Dixon recommended that Dr. Foard's office get out a letter to every
physician in the State, stating that the use of polio vaccine is approved
by the State Board of Health to be administered to any and all children
or people; that the State Board of Health advocates, recommends, or
suggests that they get those in their practice immunized before May;
that the vaccine is available to them through commercial houses. A
letter like that might make some of the doctors begin to think, Dr. Dixon
said. Another suggestion was that the State Board of Health buy an
extra ten or twenty percent at the present time, in order to get it to
the other people, with the approval of the Governor's Advisory Committee.
Dr. Foard proposed that the State Board of Health buy all the available
vaccine and furnish it, free, through local health departments, to all
physicians requesting it, with the understanding that they make no charge
for that vaccine but any charge deemed proper for administering it. Dr.
Rousseau said he thought the medical profession would object to Dr. Foard's
proposal that vaccine be provided free.
Dr. Bender moved, "that the State Board of Health go on record as
recommending to the North Carolina Advisory Committee on Poliomyelitis
Vaccine that the backlog of 160,251 ccs. of vaccine which is part of the
70 9£ allocation to commercial channels for this State and now in the hands
of the manufacturers and not being called for by wholesale druggists or
private physicians in the State, be made available for purchase by the
State Board of Health for distribution to local health departments." Dr.
Lawrence amended this motion and it was accepted by Dr. Bender,—"pro-vided,
that such parts of this vaccine as requested and needed by private
physicians for their own private patients, be made available to them at
no cost for the vaccine as long as it is available." Motion seconded by Mrs.
Latta as amended, and carried without dissent.
Dr. Rousseau said that he did not think the medical profession could
object to free vaccine, if they were at liberty to make a charge for ad-ministration.
Dr. Haywood stated that as he has been on the Board 23 years, is in
bad health and has been retired from active practice for two years, it was
his intention to offer his resignation to the Governor. He submitted a list
of suggestions which, he said, might simplify and enhance the Board's
efficient deliberations. (Recommendations filed in Minute Book)
Dr. Lawrence expressed the hope that Dr. Haywood would delay his
resignation for a little while, till the completion of his present term (May,
1957) if not a hazard to his health. Dr. Dixon said it was his opinion Dr.
Haywood has done as much as, or more than, any other member of the
Board of Health, or any member of the State Medical Society to promote
the public and general health and welfare, or any other man in the whole
State of North Carolina.
Mr. Jarrett suggested and recommended a substitute resolution, repealing
the resolution adopted at the last meeting, with reference to the Enon
Sanitary District. Mr. Byrd, a lawyer representing the district, was pre-
24 Thirty-Sixth Biennial Report
sent, and explained the legal technicality which made it necessary to change
the sanitary district. Discussion was postponed until the afternoon session,
and the meeting was adjourned for lunch at 12:30 p.m.
The afternoon session was called to order at 1:30 p.m. The first item
brought before the Board was the suggested change in the fluoridation
policy. Mr. Jarrett requested that Section IV, paragraph 7, of the fluorida-tion
policy be amended by changing the word "shall" in the second line
to "should" and adding the following sentence at the end of the paragraph:
"Where tinted or colored fluoride chemicals are not available, white
fluoride may be used, provided every necessary precaution is taken to in-sure
its proper handling and use." This would make the paragraph read
as follows:
"The fluoride chemical shall be plainly labeled and, if in dry form, should
be colored by means of a dye in order that it may be readily distinguished
from other chemicals used in water treatment processes. The dye used for
this purpose when applied to the water so as to add 1.5 p. p.m. of fluoride
(F), shall not in any way be toxic or detrimental to health and shall not
in any way effect the quality of the water in respect to the U. S. Public
Health Service Standards. The kind of coloring material used for coloring
the fluoride shall be identified by the manufacturer in his proposal. Where
tinted or colored fluoride chemicals are not available, white fluoride may
be used, provided every necessary precaution is taken to insure its proper
handling and use."
Dr. Bender moved that the policy be changed according to Mr. Jarrett's
recommendation. Mr. Lutz seconded the motion and it carried without
objection.
Dr. Lawrence moved that Mr. Jarrett's recommendation with regai'd
to the Enon Sanitary District be accepted. Dr. Current seconded the
motion and it was carried unanimously. (Resolution filed in Minute Book)
Mr. Charles Council presented a proposed revision of delayed certificate
of birth and instructions and application for filing the certificate. Mr.
Lutz moved that the revision be adopted. Mrs. Latta seconded the motion
and it was carried unanimously. (Copy filed in Minute Book)
Dr. Applewhite gave a report on the mental health program, and Mr.
Haswell described the operation of a mental health clinic (the Raleigh
Clinic).
The first draft of the recodification of public health laws had been mailed
to the Board members before this meeting. Dr. Norton announced that
a meeting of the committee which worked this out would be held on
January 18. He requested that either the Board plan to get together
with this committee, or that the President appoint a committee to meet
with this group. If it is not convenient for the entire Board or a com-mittee
to meet on that date, the date of the meeting could be changed. Dr.
Bender suggested a committee be appointed.
At this time Dr. Lawrence requested the Board to go into executive
session.
Dr. Dixon appointed Dr. Lawrence to serve with him as a committee
to meet with the committee on January 18.
North Carolina Board of Health 25
Dr. Current suggested that a copy of Dr. Haywood's recommendations
be sent to the Board members.
Dr. Elliot presented two problems with regard to consultants in the
crippled children's program. After some discussion, Dr. Dixon suggested
that Elliot bring a report to the next meeting of what has been done, with
his recommendations of what should be done.
The next meeting was set for 10:00 a.m., Thursday, February 23, and
other items on the agenda were postponed until that date.
February 23, 1956. The North Carolina State Board of Health met in
a called session, Thursday, February 23, 1956. The members assembled
in the office of Governor Luther H. Hodges, in the Capitol, where, at 9:30
a.m., Associate Justice Jeff D. Johnson, Jr., of the North Carolina Supreme
Court, administered the Oath of Office to Dr. Lenox D. Baker, Durham,
N. C, to fill the unexpired term of Dr. Hubert B. Haywood, who wrote
a letter of resignation to the Governor dated January 16, 1956.
Following the exercises in the Governor's Office, the Board went into
session in the Board Room of the Cooper Memorial Health Building. The
meeting was called to order by the President, Dr. G. Grady Dixon.
Minutes of the Board meeting held on January 12, 1956, were approved
as circulated.
Dr. Crump nominated Dr. Lawrence to fill Dr. Haywood's unexpired
term as Vice-President. Mr. Lutz seconded the motion, after which Dr.
Bender moved that the nominations be closed, seconded by Dr. Baker. The
vote was unanimous.
Dr. Lawrence moved that Dr. Bender be elected as the third member of
the Executive Committee to succeed Dr. Haywood in that capacity. Dr.
Crump seconded the motion which carried unanimously.
Dr. Lawrence moved a vote of thanks and welcome to the newest mem-ber,
Dr. Baker. This was seconded by Dr. Crump and carried unanimously.
Dr. Dixon read a message from Dr. Haywood, also a telegram from
Dr. Henderson notifying the Board that they could not be at the meeting.
Dr. Hugh A. Thompson of Raleigh and Dr. Oscar L. Miller of Charlotte,
invited guests, were recognized and asked to enter into the discussion, to
make any remarks and give any advice on the Crippled Children's Pro-gram,
which was subsequently taken up for review.
Mr. Jarrett presented the revised restaurant score sheet, copies of which
had been mailed to each member of the Board. Dr. Crump moved that the
Board approve the revised score sheet, and Dr. Current seconded the
motion. Dr. Baker abstained because he was not familiar with the sub-ject.
(Copy filed in Minute Book)
Mr. Jarrett explained a proposed order by the State Board of Health
making it mandatory for the Town of Louisburg to install an adequate
sewage disposal plant. Dr. Lawrence moved that the order be approved.
Mrs. Latta seconded it and the motion was unanimously carried. (Copy
filed in Minute Book)
Mr. Jarrett presented a petition from the Dare Beaches Sanitary
District to extend its boundaries. Dr. Crump moved that the annexation
26 Thirty-Sixth Biennial Report
be approved which was seconded by Mr. Lutz and unanimously carried.
(Copy filed in Minute Book)
Mr. Jarrett gave an explanatory report on a lawsuit that has been
entered in Wake County Superior Court against the State and the State
Board of Health by Mr. Wallace, a part-owner of the Howard Johnson
Restaurant of Rockingham, alleging that the system of grading res-taurants
and requiring the posting of grades A, B, or C, is unconstitutional.
Dr. Donald B. Koonce of Wilmington, President-Elect of the State Medical
Society, who was present, was welcomed and invited to enter into any
discussions he cared to.
Dr. Hamilton made a progress report on Postmortem Medicolegal Ex-aminations.
There are two committees functioning, a committee of the
State Medical Society and a Postmortem Medicolegal Examinations Com-mittee
set up by the 1955 Legislature. Dr. Hamilton said he felt that
the local health officer should not be considered for the job of Postmortem
Medicolegal Examiner.
Dr. Koonce was asked whether he thought the Examiner should be
the health officer. He said he was not familiar with the law that was
passed. It was his understanding of the original Bill that there would
be district pathologists, and, in each county, there would be a medical
examiner. He thought that the medical examiner certainly should not be
the health officer but, from a practical point of view, it is extremely
difficult to get a private practitioner to take that job, he said. In some
poorer counties it would be cheaper to use the health officer, he added.
Dr. Baker thought this law should have some kind of provision where
the county health officer could serve in that capacity, if the county com-missioners
could not get someone else, and that a loophole should be left
for that purpose.
Dr. Norton expressed the thought that the Laboratory Division might
be the logical place to center any special responsibility from the stand-point
of administration of work with the Postmortem Medicolegal Ex-aminations
Committee and made that recommendation. It was agreed
without formal vote that this should be done.
Dr. Foard made a progress report on the polio vaccine program, as
summarized up to the present time in material distributed to the members.
Further discussion of the Crippled Children's Program, continued from
the last meeting, was brought up and Dr. Elliot explained how physicians
get on the roster as participating specialists in the Crippled Children's
Program. He was asked at the last meeting to bring before the group
policies, plans, etc., and in the interest of giving everybody an opportunity
to study all this material at home before the meeting, he prepared and
mailed all of the important procedures, rules and regulations to each mem-ber
of the Board.
Dr. Lawrence expressed the hope that the Board could see fit to assure
that the number of participating specialists would be greatly increased.
He did not think that it should restrict the handling of these children to
the approximately 100 specialists to the exclusion of anyone else equally
well qualified.
North Carolina Board of Health 27
Dr. Baker remarked that he thought Dr. Elliot and Dr. Lawrence were
both right. Dr. Coppridge and his two associates are working in a hospital
that meets all qualifications of the Board, he said. He thought that the
vote of the Credentials Committee could be rescinded to take in these
men at both Watts and Lincoln Hospitals, in order to take care of the
children. Dr. Warner Wells (general surgeon) is not qualified for the
job for which he was applying, (that of plastic surgery) in his opinion.
Dr. Miller, who served on the Board in Washington twelve years, in
the beginning of Social Security, made the point that, above all things,
the children should be cared for. He hoped these minor problems could
be ironed out within the confines of the organization which has operated
Crippled Children's work for so long.
Dr. Thompson agreed with Dr. Miller, and added that, in handling a
program of this nature, it is necessary for the patients to be properly
taken care of by people who are fully qualified specialists, but if all are
placed on the roster who request it, it cannot be easily handled, from
an administrative standpoint.
Dr. Dixon made the point that the more people there are in this work,
the more there are who are supporting Public Health work. Dr. Lawrence
asked why so much of the orthopedic work has been sent to one hospital.
Dr. Elliot explained that the patient is treated by the orthopedist who
diagnoses his condition in the clinic. Nine out of ten attend one of the
Crippled Children's clinics throughout the State and they are hospitalized
where the orthopedist woi'ks. Orthopedists are assigned to clinics with
the recommendation of the local medical Society's Credentials Committee
and final approval by the State Board of Health. The hospital where the
patient is treated is usually determined by what orthopedist sees him in
the field.
Dr. Dixon thought the Board should know the action of the Specialty
definite program for adoption, setting forth, how it shall be done and
what shall be done; not too long, but something that can be understood
and to the best advantage of the money that goes into it, the best advantage
of the children, and the best advantage of those who are providing
the service.
Dr. Lawrence suggested that the President of the Board, together with
the Executive Committee and any other members of the Board that he
saw fit, have a meeting with the Executive Officer, Dr. Norton, and Dr.
Elliot, at which time they would attempt to work out a written policy.
Dr. Dixon thought the Board should know the action of the Specialty
Screening Subcommittees and Advisory Committee, and if the Board
should have responsibility for the action of the Advisory Committee, it
should be rseponsible for determining members of the Committee.
Dr. Norton asked if the Board wanted to pass on the members of the
Advisory Committee; if it wanted to pass on the roster of participating
specialists as they are screened through Specialty Subcommittees and then
approved or not by the Advisory Committee.
28 Thirty-Sixth Biennial Report
Dr. Lawrence said the specialists who are on this roster should have
Screening- Subcommittees and Advisory Committee approval, and also
that men declined admission to the roster should be permitted to appeal
to the Board. No objection was expressed to this statement.
Dr. Kendall explained how the question of participating consultants
came up.
It was agreed that if any action should be taken before the next meeting
of the Board, there should be consultation with the Executive Committee.
As to representation on the North Carolina Health Council, to replace
Dr. Haywood, as associate member, Dr. Dixon asked Dr. Lawrence to
serve. Dr. Lawrence asked that he be excused and suggested Dr. Crump.
Dr. Crump moved that Dr. Dixon be designated. The motion was seconded
by Mr. Lutz. Dr. Dixon voted "no," but the motion was carried. Dr. Dixon
returned to the Chair, having left it while the motion relative to him was
pending.
The recommendations and motions Dr. Haywood presented to the Board
in a written statement at the last meeting were taken up individually,
as follows:
"I move that the Executive Committee of the State Board of Health
meet once a month." Dr. Crump seconded the motion. Dr. Baker asked
for an amendment to the motion, "meet four times a year, spaced between
and in addition to regular Board meetings." This amendment was accepted
by Dr. Crump and Dr. Lawrence seconded the amendment. If there is
a called meeting of the Board, it will serve as a regular meeting of the
Executive Committee. Unanimous.
"I move that the members of the Executive Committee serve staggered
terms of three years each and that an interim of at least two years shall
intervene before they are re-elected to the Executive Committee." No
second.
"I move that the Chairman of the Board of the State Board of Health
shall serve not over six years consecutively and that a three year period
shall intervene before he may be re-elected Chairman." No second.
"I move that this shall also apply to the Vice-Chairman." No second.
"I move that a Finance Committee be elected by the Board from their
members by the Boaid, to serve as the other Boards will do for three year
periods, on a staggered basis." No second.
"I move that a Grievance Committee be elected by the Board from its
members to hear any complaints from employees about promotions and
salary raises." No second.
"I move that committees be appointed to confer with and familiarize
themselves with the various departments (divisions) of the State Board
of Health." Dr. Current suggested one Board meeting be devoted to hear-ing
division reports. Dr. Bender moved that there be a liaison officer
from the Board to represent each division of the State Board of Health,
seconded by Dr. Current. Each member present was given opportunity
to express a preference and Dr. Dixon filled in the remainder as follows:
North Carolina Board of Health 29
Central Administration Mrs. J. E. Latta
1. Personal Health Division Dr. Lenox D. Baker
2. Epidemiology Division Dr. John P. Henderson, Jr.
3. Sanitary Engineering Division Mr. H. C. Lutz
4. Oral Hygiene Division Dr. A. C. Current
5. Local Health Division Dr. John R. Bender
6. Laboratory Division Dr. G. Curtis Crump,
leaving the Board President and Vice-President without specific liaison
assignments. It was discussed that these liaison assignments to divisions
should be rotated at about yearly intervals in order that all Board mem-bers
could become familiar with the entire program.
"I move that at least one meeting of our Scheduled four meetings
relationship to the State Board of Health's programs." No second.
"I move that a committee be appointed on Social Legislation and its
be devoted to a large extent in getting reports from these committees."
No second, but with comment that liaison responsibilities assigned above
should assure adequate reporting to the full Board.
Dr. Bender moved that the two motions that were revised and amended
be accepted by the Board. Dr. Lawrence seconded the motion and it was
unanimously carried.
Dr. Dixon expressed the hope that the Board would pass a similar reso-lution
for Dr. Haywood as for Dr. Johnson, ten or twelve years ago, printed
on a parchment scroll. Dr. Lawrence moved that a suitable resolution of
respect and appreciation and gratitude to Dr. Haywood for the services
rendered this Board be prepared and signed by each member of the Board,
and that the Board as a whole, or committee designated, present it to him,
preferably, if he is able to be there and his health will permit, at the next
Conjoint Session of this Board and the State Medical Society. Seconded
by Dr. Current, and unanimously carried.
Dr. Dixon asked every member of the Board to go over the second
draft of the proposed recodification, make notations of the changes that
have been made that they do not agree with, or changes that they think
should be made, and after they have gone through this, then reduce that
to a letter or statement, chapter by chapter, and if there is any member
of the Board that does not want to make any suggested changes, so write
the State Health Officer. When all members of the Board have been heard
from,—that a special meeting be called to go over that for its last
approval or disapproval. Dr. Lawrence made such a motion. Seconded by
Dr. Bender and unanimously carried.
April 19, 1956. On Thursday, April 19, 1956, the Executive Committee of
the State Board of Health composed of Dr. G. Grady Dixon, Dr. Hen J.
Lawrence and Dr. John R. Bender, met. Dr. Dixon called the meeting to
order.
Mr. John Andrews presented a proposed revision in the hulk milk dis-penser
requirements of the restaurant regulations. Item 17 of the res-taurant
regulations (page 27) allows the use of bulk milk dispensers. The
milk regulations adopted by the Richmond County Board of Health do not
allow the use of bulk milk dispensers in Rishmond County. Possible con-
30 Thirty-Sixth Biennial Report
flicting interpretations can be eliminated by changing the State Board of
Health restaurant regulations to allow bulk milk dispensers "where per-mitted
under the regulations of the local Board of Health." If the State
Board of Health should decide to make this change, the clause quoted could
be inserted on line 8 of Item 17 (page 27), between the words "that" and
"sanitary." With this change, the third sentence of Item 17 would read as
follows (addition underlined)
:
"Milk and milk products shall be served in the individual, original con-tainers
in which they were received from the distributor, so that the name
and grade of the contents and the name of the milk distributor may be
oberved readily by the consumers; provided that, where permitted under
the regulations of the local Board of Health, sanitary bulk milk dis-pensers
which have been approved by the State Board of Health may be
used if so located and so labeled that the name and grade of the contents
and the name of the milk distributor may be observed readily by the
consumers; provided further, that in the case of restaurants and hotels
having several banquet halls and dining rooms served from a central
kitchen, if careful investigation proves it impractical to locate the milk
dispenser in a dining room because of established food checking and serv-ing
routines, the milk dispenser may be installed in the food serving area
of the kitchen in a location specifically approved by the health officer
and the label information required by this item shall be shown prominently
on the menu cards instead of on the milk dispenser cabinet."
Dr. Lawrence moved that the revision be adopted. Dr. Bender seconded.
At Dr. Norton's request, Mr. Andrews reported on how the Howard
Johnson litigation was settled. He also commented that relations with
Howard Johnson Restaurants is, in general, good.
Dr. Foard gave a brief report on the distribution of polio vaccine with a
total allocation to date for North Carolina of about 940,000 ccs. from
Federal funds.
Dr. Norton read a letter from Dr. LeRoy Hand, Jr., Gatesville, which
had been published in the News and Observer. He reported that he had
written Wyeth and Lilly for comments on Dr. Hand's letter.
Dr. Norton asked Dr. Foard to give a brief report on Cabarrus County.
A little more than 80 per cent of the children under 20 in Cabarrus County
have been given two doses of polio vaccine, and the County Medical Society
has requested enough vaccine to make a hundred per cent. The Public
Health Service plans to use Cabarrus County in a study on the effects
of administration of polio vaccine. Practically all of the vaccinations were
done by the health department—the Medical Society advocated that people
go to the health department.
Dr. Norton reported that he and Dr. Rousseau both feel that the useful-ness
and necessity for the Polio Advisory Committee has just about ended,
from the standpoint of having anything other than the State Board of
Health pick up and carry on from there. Dr. Rousseau is in complete agree-ment
and actually recommends that we go ahead and make a report to the
Governor on the progress of the vaccination against polio. He suggested
that Dr. Norton gather up the information, summarize it and take it over
to the Governor and suggest to him that he terminate the Advisory
Committee and designate the State Board of Health to follow-up with
North Carolina Board of Health 31
that. Dr. Bender commented that the State Board of Health might be
glad to have this committee if a lot of polio breaks out this summer and
other Executive Committee members seemed inclined to agree with him.
Dr. Dixon introduced Dr. Ellen Winston and Dr. John Ferrell, who
had joined the group to present the proposal of the State Health Council
for first aid service for State employees. Dr. Winston gave the background
and described the proposed plan worked out by a committee of the State
Health Council for a preventive health service for State employees for
the purpose of reducing absenteeism, reducing labor turnover, improving
employees' morale and greater working effectiveness. It was suggested
that one station, under the supervision of the State Board of Health, be
staffed with one nurse, on a pilot basis, for State employees in Raleigh
only. Dr. Ferrell described the State program in Connecticut, the only
state which has such a program, and also commented briefly on the
emergency service in Washington which was developed and supervised
by the U. S. Public Health Service for Federal employees.
After much discussion, Dr. Lawrence suggested that the matter be
taken under advisement and referred to the full Board.
Dr. Foard reported to the Committee that he and Dr. Norton just
found out about an industry tax collected for industrial health purposes
of about $150,000 per annum which has been going into the State General
Fund. He also mentioned the fact that because of the low salaries paid
by the State, the Industrial Hygiene Section has been without an engineer
since the death of Steve Marsh last July. Dr. Dixon suggested that we
find out several things; first, when that tax was levied, how long it has
been collected, and why it was collected and how much is collected annually,
if it was levied for the purposes of industrial health, who has that money
been assigned to?
Dr. Foard called attention to the growing hazard of the use of atomic
energy in industrial plants, and the need for more personnel in the Indus-trial
Hygiene Section. Dr. Foard recommended that the State Board of
Health take under consideration a resolution that would recommend ade-quate
support from an industrial hygiene appropriation standpoint. Dr.
Dixon requested a report on answers to the above questions to the next
meeting of the Board on May 2nd.
Adjourned for lunch.
The next item taken up by the Committee was discussion of the Haywood
scroll. It was left up to Dr. Hamilton to have the scroll made up and to
have it at the Conjoint Session at Pinehurst for presentation. Dr. Dixon
took personal responsibility for the members of the Board taking care of
the cost, which will be about $100.00.
Mr. Roddey Ligon, of the Institute of Government, Chapel Hill, made a
progress report on bringing health regulations up-to-date. He said that
suggested changes in Chapter 130 will be in Dr. Norton's hands in a few
days. Other areas outside of Chapter 130 will be taken up with the State
Department of Agriculture and any other departments involved before
any changes can be made. Dr. Dixon told him that a committee of the
32 Thirty-Sixth Biennial Report
Board will have a meeting on April 29 and may have some suggested
changes to turn in to him.
Dr. Applewhite presented proposed changes in board policies on allo-cation
of funds to local health departments, with reference to oral hygiene
programs in the local departments. Miss Deynolds presented the budget
programs in the local departments. Miss Reynolds presented the budget
Dr. Applewhite and Dr. Branch to work out and bring up at the next
meeting.
Dr. Elliot asked for approval of the Board for the way the Crippled
Children's program has been operated up to now, with the understanding
also that the Board will in the future, determine any new policies, changes
in policy, selections of clinic directors, additions to the participating roster
and to the Advisory Committee and Credentials Committees. He also re-quested
approval of the two recommended for addition to the roster. (Dr.
Louis Carroll Roberts and Dr. Jack Hughes of Durham).
Dr. Norton was requested to prepart a resolution to the whole Board
that this committee be set up as the formal advisory committee, that they
be commissioned by the Board of Health and that they be commissioned
for two and four years, alternately and alphabetically on the list.
Formal action on the Credentials Committees was postponed. With ref-erence
to the two urologists to be admitted to the roster, Dr. Roberts and
Dr. Hughes of Durham, Dr. Lawrence moved that approval be rocemmended
and Dr. Bender seconded the motion.
May 2, 1956. The annual meeting of the North Carolina State Board of
Health was held at the Carolina Hotel, Pinehurst, North Carolina, May 2,
1956, with President Dixon presiding.
The meeting was called to order by the President. Minutes of the Board
meeting held on February 23, 1956 were approved with an amendment
suggested by Dr. Lenox Baker relative to "Liaison assignments" to
divisions. This correction has been made.
Dr. Baker moved that the minutes of the Executive Committee meeting
held on April 19, 1956, be held in abeyance until a future meeting. Motion
seconded by Dr. Current, and carried.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was
present and presented a proposed resolution regarding bulk milk dis-pensers.
Mr. Jarrett discussed the subject in detail and said there was a
possibility of a conflict between the regulations of the State Board of
Health and the milk regulations of local Boards of Health. The possibility
of such a conflict could be prevented by changing the State Board of Health
regulations governing the sanitation of restaurants, private hospitals,
sanatoriums, sanitariums, educational institutions, and summer camps so
as to permit the use of bulk milk dispensers "where permitted under the
regulations of the local Board of Health." Upon motion of Dr. Current,
seconded by Dr. Baker, the following resolution was unanimously adopted:
—
"Be it resolved that the rules and regulations governing the sanitation of
restaurants, as adopted by the State Board of Health at Winston-Salem.
North Carolina, on September 23, 1955 be amended as follows:
"In Section 6, Item 17, third sentence, after the words 'provided that,' insert
North Carolina Board of Health 33
the words, 'where permitted under the regulations of the local Board of
Health';
"Be it further resolved that the rules and regulations governing the
sanitation of private hospitals, sanatoriums, anitariums and educational
institutions, as adopted by the State Board of Health at Raleigh, North
Carolina on August 7, 1946 and revised at Raleigh, North Carolina on
July 1, 1954, be amended as follows:
"In Section 6, Item 16 (as revised), seventh sentence, after the words
'provided that,' insert the words, 'where permitted under the regulations
of the local Board of Health';
"Be it further resolved that the rules and regulations governing the sani-tation
of summer camps, as adopted by the State Board of Health at
Virginia Beach, Virginia on May 14, 1947, and revised at Raleigh, North
Carolina on July 1, 1954, be amended as follows:
"In Section 7, Item 10 (as revised), seventh sentence, after the words
'provided that,' insert the words, 'where permitted under the regulations
of the local Board of Health.'
In Dr. Fred T. Foard's absence, who was in Washington, D. C. attending
a conference on poliomyelitis vaccine called by Surgeon General Scheele,
representing the North Carolina State Boai'd of Health, Secretary Norton
made a progress report on polio vaccine. He stated that the Board had
just received a wire announcing the largest shipment of vaccine yet
(96,000 ccs.) and that it was understood that there was an increasing
amount of vaccine in the assembly lines which takes about four months to
complete and that it is expected that soon the vaccine will be coming in
in increased amounts. Dr. Norton also discussed a report on poliomyelitis
vaccine which had been circulated to all Board members regarding the
vaccine distribution to be discussed at a meeting to be held Sunday, May
6, with the North Carolina State Advisory Committee on Poliomyelitis
Vaccine and as Chairman of that Committee invited Board members to
attend. Dr. Dixon stated he would try to attend.
At the request of Dr. Norton, Mr. William H. Richardson, Publicity
Officer, reported the results of an investigation concerning monies paid
into the Industrial Commission by self-insurers. There had been some mis-understanding
as to whether these monies, which are deposited in the Gen-eral
Fund, could be retrieved and used by the State Board of Health or the
Industrial Commission. It was learned that this fund, amounting to an
average of around $130,000 a year, is collected for purposes other than
services provided by the State Board of Health.
Dr. C. C. Applewhite, Director of the Division of Local Health, presented
the proposed policies of the North Carolina State Board of Health for
allocation of State aid funds to local health departments. The policies were
explained very carefully by Dr. Applewhite and discussed. Upon motion
of Dr. Lawrence, seconded by Dr. Current, the new "Policies of the North
Carolina State Board of Health for Allocation of State Aid Funds to Local
Health Departments" were unanimously passed. (Copy of policies filed
in Minute Book
)
Dr. Applewhite also presented proposed policies of State and Federal
Funds for the Mental Health program. After due explanation, and dis-cussion,
Dr. Lawrence moved, and seconded by Dr. Current, that the Board
postpone definite action on Mental Health policies until a subsequent date
34 Thirty-Sixth Biennial Report
but authorized the State Board of Health to proceed as usual with the
allocation in accordance with previously used methods.
Mr. Jarrett presented a request for the creation of a sanitary district at
Havelock, Craven County, North Carolina. He stated that all documents
and transactions had been examined by his office and were in his opinion, in
order, and in compliance with the law, and he recommended that the State
Board of Health act favorably on the creation of this Sanitary District.
The matter was discussed and upon motion of Dr. Current, seconded by
Dr. Henderson, the "Resolution of the North Carolina State Board of
Health creating the Havelock Sanitary District in Craven County" was
unanimously passed.
Mr. Jarrett also presented a x-equest for the extension of the boundaries
of the Walkertown Sanitary District in Forsyth County. He stated that
the documents, as well as the various transactions relative to this matter
had been examined by his office and were in order, and because of the need
for sanitary improvements in the proposed area to be annexed, he recom-mended
favorable action by the Board. On motion of Dr. Baker, seconded
by Dr. Lawrence, the "Resolution extending the boundaries of the Walker-town
Sanitary District in Forsyth County, North Carolina," was passed
unanimously. (Copy of resolution filed in Minute Book)
Then, Mr. Jarrett presented a request from the Town of Mebane, North
Carolina, to allow controlled fishing in the municipal water supply lake.
He stated that due to strict regulations controlling fishing activities that
he felt that no unfavorable effects would be experienced in the quality of the
water and that it would be safe from a public health standpoint. On motion
of Dr. Baker, seconded by Dr. Current, the "Resolution of the North Caro-lina
State Board of Health authorizing the Town of Mebane, North
Carolina to permit fishing in Lake Michael Municipal Water Supply Lake,"
was passed unanimously.
Dr. Dixon announced the meeting of the North Carolina Public Health
Association to be held in Charlotte, North Carolina, May 31-June 1, 1956.
The question as to whether or not a Board meeting should be held during
the meeting was discussed, etc. Dr. Bender moved, and it was seconded by
Dr. Henderson, that if there is enough Board business, that the Board
hold a regular meeting at 2:00 p.m. on Friday, June 1 at the same time and
place of the NCPHA meeting at Hotel Charlotte. Motion carried.
Secretary Norton discussed the letter he had sent to Mr. George B.
Cherry, Superintendent of Buildings and Grounds, requesting consideration
of air-conditioning of the Health Building and that if the entire building
could not be air-conditioned, special consideration was requested for the
first three floors of the building. The Board approved of the Secretary's
request for air-conditioning, and asked that Mr. Cherry be informed that
the Board officially and respectfully requests that the entire building be
air-conditioned as soon as possible.
Dr. B. M. Drake, Co-Director of the School Health Coordinating Unit,
which is a coordinated service jointly of the Education Department and
the State Board of Health, gave a brief summary of the School Health
Program. He discussed the functioning of the service for the last two
North Carolina Board of Health 35
years and brought the Board up-to-date as to the restrictions placed on
the use of school health funds by the last Legislature. Dr. Drake also cir-culated
to the members other pertinent data: policy governing the expendi-ture
of State Board of Education Child Health funds, a schedule of dental
fees and a copy of a memorandum to Dr. Norton concerning the formation
of a joint school health committee. After a discussion, it was suggested
that Dr. Drake and Mr. Charles E. Spencer, who is also Co-Director, draw
up resolutions relative to the joint Committee that they would be willing
to have presented to both departments (State and Education Boards) at
the next meeting of the Board.
At this point, Dr. Crump moved and Dr. Baker seconded that the Board
declare itself in Executive Session. Motion carried.
Mr. James T. Barnes, Chairman of a Committee of the N. C. Health
Council, was invited to the meeting. He explained the establishment of a
first aid station for State employees—the Health Council having adopted
this one project for the year; that the purpose was not treatment of ail-ments
except basic first aid. The three functions of the station would be:
screening, providing aid for minor ailments in order that an employee
might stay on the job, and prevention through education. (A description
of Preventive Health Service for State Employees as prepared by Mr.
Barnes had previously been mailed to each member). Dr. Baker moved
that the State Board of Health, as of now, go on record as disapproving the
health service as outlined by the Committee for State employees. Motion
seconded by Dr. Bender, and passed unanimously.
There was only a brief discussion of the progress on recodification of
health laws and regulations. It was moved by Dr. Crump, and seconded
by Dr. Lawrence, that the President of the Board of Health appoint a
committee from the Board to make an official draft of the recodification of
the public health laws of North Carolina. Motion carried. Dr. Crump was
appointed Chairman of this group with power to select other members
from the Board, and to get together at any time to study in particular
the sections on oral hygiene, pharmacy, medical laws and regulations,
sanitation, dairying, etc.
On motion duly made and seconded, the meeting adjourned for the Con-joint
Session of the Medical Society of the State of North Carolina and the
State Board of Health as required by law on the second day of the annual
meeting of the Medical Society. President Dixon presided at this meeting.
After the recognition of the now member, Dr. Lenox D. Baker, the Secre-tary,
presented his annual report. President Dixon then called Dr. Ernest
A. Branch to the platform and praised his leadership, internationally rec-ognized,
in Oral Hygiene work which has reflected credit on the Board,
the State and on Dr. Branch and the entire dental profession.
President Dixon then called Dr. Hubert Haywood to the platform and
presented to him a scroll prepared by fellow Board members in recognition
of his distinguished service in his work with the Board as a member, and
on the Executive Committee and as Vice-President. A copy of the scroll
follows:
36 Thirty-Sixth Biennial Report
"TRIBUTE OF ESTEEM, LOVE AND AFFECTION TO
DR. HUBERT BENBURY HAYWOOD, B.Ph., M.D., L.L.D.
"The North Carolina State Board of Health wishes to recognize with
sincere appreciation and respect the faithful service and splendid leader-ship
furnished by HUBERT BENBURY HAYWOOD. Born in Raleigh in
1884, he has engaged in the general practice of medicine in Raleigh all of
his professional life. In this individual and family servce he has attained
happiness and eminence and developed the background of understanding for
guidance in preventive health services for his community and State. First
appointed to The Board by his trusted friend, Governor J. C. B. Ehringhaus
in 1934, each of the succeeding Governors, Hoey, Broughton, Cherry, Scott
and Umstead, respectively, reappointed him to succeed himself. Much of
the progress of public health in North Carolina during the last 20 years
may be attributed to his vision, his matchless and sterling character, and
the persuasive power of his diplomacy on many occasions. He has been
faithful in his efforts on behalf of the State Board of Health and matters
assigned to him have received his careful and painstaking consideration.
"DR. HAYWOOD is a Fellow of the American College of Physicians, a
member of the American Medical Association, a member and past president
of the Medical Society of the State of North Carolina and the Raleigh
Academy of Medicine, and a lineal descendant of one of the original
founders of The Academy. He was one of the senior members of the State
Board of Health, and at the time of his resignation was Vice-President
and a member of its Executive Committee. He wears his laurels with such
dignity, refinement and scholarly understanding, together with his ever
present genial smile and love and affection for his fellowman that these
qualities clearly mark him as an understanding and loyal friend, an emi-nent
physician and scientist.
"We salute you, DR. HAYWOOD, and bespeak for you that degree of
satisfaction and sweet calm that can come only to one who has lived a
rich and useful life in devoted and dedicated, and always intelligently
constructive medical and health service to this and all future generations
in North Carolina.
Signed: G. Grady Dixon, M.D., President
Ben J. Lawrence, M.D., Vice-President
John R. Bender, M.D.
A. C. Current, D.D.S.
G. Curtis Crump, M.D.
H. C. Lutz, Ph.G.
Mrs. J. E. Latta
John P. Henderson, Jr., M.D.
Lenox D. Baker, M.D.
J. W. R. Norton, M.D., State Health Officer
John H. Hamilton, M.D., Asst. State Health Officer.
June 1, 1956. A meeting of the North Carolina State Board of Health
was held at the Hotel Charlotte, Charlotte, North Carolina, Friday, June
1, 1956, 2:00-5:36 p.m., at the time and place of meeting of the 45th Annual
Session of the North Carolina Public Health Association, with President
Dixon presiding.
Also present for the meeting were Eugene A. Gillis, M.D., Region III
Medical Director, USPHS, M. B. Bethel, M.D., Mecklenburg County Health
Officer and E. H. Ellinwood, M.D., Guilford County Health Officer, both
Past Presidents of the NCPHA, and Dr. Bethel is President of the Mecklen-burg
County Medical Society; and E. G. McGavran, M.D., Dean of the UNC
School of Public Health and President of the NCPHA.
North Carolina Board of Health 37
Dr. Gillis, Regional Medical Director of Charlottesville, Virginia, at
the invitation of President Dixon, gave an informative discussion regarding
the poliomyelitis vaccine allotted to North Carolina. He reported on the
amount of vaccine which has stockpiled from manufacturers and remained
unsold to druggists and physicians in North Carolina. He pointed out that
the present 30 per cent to public agency and 70 per cent to private physi-cians
as allocated by the State Poliomyelitis Vaccine Advisory Committee
also provided that counties may become eligible to receive additional
amounts on official requests from both the local health officer and the
local medical society. He suggested that it might be well to devise some
other plan since some of this accumulating surplus vaccine is not available
to any one. With a present accumulation of over 100,000 ccs. surplus and
a new total allotment of 245,000 ccs. today he reported that among the
states in Region III North Carolina has the greatest accumulation of vac-cine
allocated for use by private physicians and undistributed by the manu-facturers,
and that other states are clamoring for it. Dr. Baker objected
to the reference to the surplus in the 70 per cent allocation and also in
regard to the occasional erroneous impressions left by newspaper publicity
that seemed unduly critical of private physicians. Dr. Baker moved that
the State Board of Health employee personnel be instructed by this Board
not to release any more publicity in regard to the vaccine program that
even mentions the 30% -70% distribution. Dr. Lawrence said he would like
to second this motion with this amendment, which was accepted by Dr.
Baker, "that no release be given out for publicity until said release has
been carefully scrutinized by Dr. Norton, or someone designated by him
to make certain that there is nothing in such release to reflect undue criti-cism
upon the private practitioners of this State." Dr. Lawrence asked
Dr. Norton if this was agreeable with him. Dr. Norton commented that he
considered such a motion unnecessary and since Board minutes are public
property it might be subject to interpretations unfavorable to the Board
from a public relations standpoint. "Dr. Baker explained that the reason
for his motion was the publicity that had come out of Raleigh, regardless
of its source, had insinuated that 70% of the vaccine was being held tied
up by private physicians for their use and was not available to the public
health services and that it had not been made clear that, even though the
vaccine was subject to being so issued, that any and all vaccine was subject
to release and was available for purchase by public health agencies by
the simple process of the local health departments with the approval of
the local medical societies, applying for additional funds for purchasing
such vaccine which is on the market and which is available. Previous
publicity has not explained this aspect of the situation satisfactorily and
there has been confusion both on the part of the public and many of the
physicians of the State who have been justifiably concerned regarding the
poor light in which the medical profession has been thrown by the failure
of the public not getting a truer understanding of the situation." Motion
unanimously carried.
The minutes of the Board meeting held on May 2, 1956, were approved.
Action on the minutes of the Executive Committee Meeting held on
38 Thirty-Sixth Biennial Report
April 19, 1956, was deferred until the next meeting of the Executive Com-mittee.
Dr. John H. Hamilton, Director of the Laboratory of Hygiene Division,
was present and discussed the advisability of expanding the cytology serv-ice.
He reviewed what the Laboratory has been doing in cytology as a back-ground
and the policy that has been followed for the last twelve years.
He added that any expansion for the next three years would best be re-flected
in the early fall budget presentation. Dr. Lawrence moved that
whereas Dr. Hamilton has seen fit to present to the Board some remarks
with reference to this service which has been rendered in the field of cancer
cytology, namely, Papanicolaou, and whereas it appears from his brief
presentation that it is a service which the Laboratory of Hygiene could
advisedly render to the people of this State, and whereas the State Board
of Health desires the full cooperation and support of the Medical Society
of the State of North Carolina in its effort to render service to this State,
the Board requests that Drs. Hamilton and Norton should, at such time as
feasible, secure the opinion of the Medical Society of the State of North
Carolina, and report back to the Board. Motion seconded by Mr. Lutz.
Dr. Bender expressed a belief that the Board should make its own decision
now. Motion carried.
Dr. A. H. Elliot, Director of the Personal Health Division, presented a
request from Dr. Ann DeHuff Peters of the North Carolina Memorial
Hospital, Chapel Hill, to use only normal salt solution in the eyes of new-born
babies instead of silver nitrate. Dr. Elliot stated that he had written
Dr. Peters that the question of permitting the use of antibiotics in the
eyes of the newborn instead of silver nitrate had been presented to the
Board on several occasions but at no time had serious consideration been
given to departing from the use of silver nitrate (except in a proposed
study of the effectiveness of penicillin at the medical schools). The matter
was discussed at length, but no action was taken and deferred until the
next Board meeting, in order for the Board to consider the feasibility of
carrying out such a suggested procedure as outlined by Dr. Peters. Dr.
Norton was requested to secure information on what materials other than
silver nitrate had been used in this State and elsewhere and with what
results. Such information should be presented at the next meeting of the
Board. Dr. Baker suggested that it might be best for the Board to reach
a decision as to what they thought would be best and let it be written into
law.
Dr. Elliot also discussed the Crippled Children's program very briefly,
and stated that the Credentials Committee on Urology and the Advisory
Committee to the Crippled Children's program has approved Dr. Jack
Hughes and Dr. Louis Carroll Roberts of Durham for admission to the
Crippled Children's roster of Urology specialists and asked that the approval
of the State Board of Health be given. Dr. Baker moved that Doctors
Hughes and Roberts be approved by this Board for urology in the Crippled
Children's Section as recommended by the Credentials and Advisory Com-mittees.
Motion seconded by Dr. Current, and carried.
North Carolina Board of Health 39
Secretary Norton gave a brief report on the activities of the North
Carolina Cancer Institute in Lumberton. The trusteees of the North Carolina
Cancer Institute, the North Carolina Division of the American Cancer
Society and the Cancer Committee of the Medical Society of the State of
North Carolina recommended an institution for treatment and care of
indigent terminal cancer patients at or near a teaching center, and asked
that Dr. Norton bring the matter before this Board. The subject was dis-cussed
at length. Dr. Current moved, seconded by Dr. Baker, that the
Board of Health act favorably upon the following resolution.—"that an
institution for care and treatment of terminal cancer patients be estab-lished
at or near a teaching medical center." Motion carried unanimously.
Then Secretary Norton requested informal comment on whether or not
the Board would approve having funds for the institution, referred to
above, if established, coming through our budget office as was done with
funds for renovation of the Cancer Institute at Lumberton. It was the
consensus that the Board would prefer that our budget office not handle
this item.
Dr. Elliot suggested to the Board that Dr. W. Ralph Deaton, Jr., of
Greensboro, be approved for lung surgery by the Board; and further that
Dr. Deaton's approval for heart surgey be delayed until he has had more
experience in this field in accord with recommendations of the appropriate
Credentials Committee. Dr. Elliot submitted data on Dr. Deaton's prepara-tion,
training and experience. Dr. Baker moved, seconded by Mr. Lutz,
that Dr. W. Ralph Deaton, Jr., of Greensboro, North Carolina, be approved
as recommended by the Credentials Committee for lung surgery. Motion
carried. Approval for heart surgery was withheld until the applicant has
had more experience in this field.
In the absence of Dr. G. Curtis Crump, Chairman of the Committee to
study the revision and recodification of public health laws, Dr. Dixon made
a brief report. He also stated that Dr. Crump wished to be relieved of this
chairmanship as he was so far away from the center of the State and that
the Committee would get together and name a chairman later. In discuss-ing
revisions in the public health laws, the Board especially took cognizance
of the change in designating the title of Secretary and State Health Officer
to Commissioner of Health. At a meeting on Septemebr 23, 1955, a motion
was made by Dr. Crump, seconded by Dr. Current, suggesting the following
terminology: "that the term 'Commissioner of Health' or 'Health Commis-sioner'
be used instead of the present 'Secretary-Treasurer and State
Health Officer.' " Dr. Current moved that the terminology used in the
minutes of the September 23, 1955 Board meeting be rescinded and that
the Board continue to use the title of "Secretary-Treasurer and State
Health Officer" as at present. Dean McGavran asked if he might comment
on the basis for the general trend away from the use of "Officer" in many
states, but Dr. Lawrence insisted that the vote be taken and that then a
courteous hearing be accorded Dr. McGavran, and this was done. Motion
seconded by Mr. Lutz, and carried.
In a further discussion of the Crippled Children's program and Advisory
and Credentials Committees, the following motions were made: Dr. Baker
40 Thirty-Sixth Biennial Report
moved that the names of Dr. Julian Deryl Hart, Duke Hospital, Durham and
Dr. N. A. Womack, N. C. Memorial Hospital, Chapel Hill, be deleted from
the thoracic and cardiac Credentials Committee. Motion seconded by Dr.
Lawrence, and carried.
Dr. Baker moved that the name of Dr. James Austin Valone of Raleigh
be added to the list eligible for plastic surbery. (There was no report of
request to, or action by, the Credentials Committee). Motion seconded by
Dr. Lawrence, and carried.
Dr. Baker moved that Dr. J. Leonard Goldner, Durham Orthopedist and
hand surgeon, be added to the Advisory Committee. Motion seconded by Dr.
Bender, and carried.
Dr. Lawrence moved that the name of Dr. Frank R. Johnston, Genei'al
Surgeon, Bowman-Gray School of Medicine, Winston-Salem, be added to
the Advisory Committee list. Motion seconded by Dr. Bender, and carried.
Dr. Baker moved that Dr. J. S. Gaul, Orthopedist, be removed from the
Advisory Committee of the Crippled Children's Section and that his son,
Dr. John Stuart Gaul, Jr., be added instead. Motion seconded by Dr. Law-rence,
and carried.
Dr. Baker moved that the President-Elect of the North Carolina Academy
of General Practice be made an ex-officio member of the Advisory Com-mittee
of the Crippled Children's Section. Motion seconded by Dr. Lawrence,
and carried.
Dr. Baker moved that Dr. Wayne Jefferson Benton of Greensboro, be
made a member of the advisory Committee of the Crippled Children's
Section. Motion seconded by Dr. Lawrence, and carried.
On motion duly made and seconded, the meeting adjourned at 5:.°>0 p.7n.
North Carolina Board of Health 41
CHRONIC DISEASES-A JOINT
RESPONSIBILITY OF PRIVATE PRACTICE
AND PUBLIC HEALTH *
By J. W. R. Norton, M.D., M.P.H., F.A.C.P.* ::
Raleigh
In the long span of recorded time on this planet fifty years is as the
twinkling of an eye but medical progress during this period has exceeded
that of many prior centuries. For the twenty-eighth year after the estab-lishment
of the North Carolina State Board of Health, Dr. Cooper in his
chronological summary for 1905 had this to say for a year just before the
beginning of intensified joint efforts against communicable diseases:
"General Assembly established State Laboratory of Hygiene; imposed
water tax of $64 on all public water companies; voted $600 annually for
the support of laboratory. Small appropriation made it necessary for the
Department of Agriculture to continue to assist State Board of Health.
Annual appropriation, $2,000."
Even the barest outline or summary this year of public health services
provided by the state and the sixty-nine local health departments serving
all 100 counties would require many pages. Concurrently with the well-known
vast and rapid changes in the private practice of cm-ative medicine
has come similarly impressive progress in preventive medicine and public
health. Through the years a few physicians have voiced fears that they
would have no work if preventive measures were applied to all ills and
injuries practically preventable. We heard such comments from a few with
regard to vaccinations against smallpox, typhoid, diphtheria, whooping-cough
and tetanus, against the planned parenthood program, against the
school health program, against the venereal disease and tuberculosis con-trol
programs. We hear less of these short-sighted objections today but
there are a few who would limit public health sei'vices to the indigent and
against only the communicable diseases.
With improved educational methods and more widespread use of pre-ventive
measures, prompt diagnosis and greatly enhanced effectiveness of
treatment procedures the communicable diseases have come under rela-tively
effective control with the exception of tuberculosis. Recent examples
are the Salk vaccine against poliomyelitis and certain antibiotics against
rheumatic fever. The former Captain of the Men of Death, tuberculosis,
has dropped until now it is not even among the first ten killers except in
limited age groups.
In 1954 diseases of the heart and blood vessels, cancer, accidents, nephri-tis
and diabetes accounted for 22,62:; deaths out of a total of 32,072 in
North Carolina. Mental disorders accounted for half the persons hospitalized.
* Read before the Conjoint Session of the Medical Society of North Carolina and the Slate
Board of Health, l'inehurst. May 4. L956.
** Secretary-Treasurer of the State Hoard of Health and State Health Officer.
42 Thirty-Sixth Biennial Report
Arthritis caused an enormous amount of disability and hospitalization.
Improper nutrition caused decreased vitality and lowered efficiency in
many. All these, except accidents, are in the non-communicable field or area
of chronic disorders. Most medical leaders agree that much progress could
be made against them by health education, early diagnosis and prompt
medical treatment and supervision.
We are now at about the stage of medical knowledge regarding these
chronic non-communicable disorders in which our predecessors found them-selves
when joint efforts of private practice and public health began to be
coordinated against the communicable diseases. The opportunity is afforded
us to proceed humanely and cooperatively as was done so successfully
against the infectious diseases.
When the Medical Society of North Carolina stimulated the establish-ment
of the State Board of Health and local health departments, medical
leaders considered the situation with regard to communicable diseases to
be intolerable. Our successful joint efforts have prolonged the life span
and helped to create the present intolerable situation with regard to the
chronic non-communicable disorders and our mechanical progress has con-tributed,
at least in part, to our deplorable accident situation. Even such
problems as rehabilitation and stream and atmospheric pollution should
be of active concern to physicians in private practice and in public health.
In one week in December, 1952, the London smog accounted for more excess
mortality, even in proportion to the population, than during any week of
the great cholera epidemic of 1866.
Our state is fortunate in that we have an alert medical profession well
represented on the state and local boards of health. We are one of the few
states with full coverage by sound local health departments. We have made
a beginning in cardiovascular disease diagnostic work. We have a good
start in finding cancer in the early stages when, in many cases, something
can be done to control it—provided the diagnostic efforts are not diverted
too obviously into estimating the size of the pocketbook before proceeding
with a medical diagnosis. Harnett County has an excellent program of
diabetes case-finding and supervision and physicians throughout the state
have cooperated in the annual week of diabetes case-finding. Cumberland
County has started an obesity control service. Halifax, Harnett and some
of the other counties have had limited experience in multiple screening
technics. The mental health services have expanded recently along lines
similar to the tuberculosis control work for early case-finding, guidance
and then post-hospitalization follow-up to prevent a breakdown. The nutri-tion
service has been strengthened. A recent grant by the Kellogg Foun-dation
has enabled the beginning of an intensive program in control of
home and farm accidents. A cooperative program with the Motor Vehicle
Bureau has been stimulated by Cornell University consultants in a study
of motor vehicle design as it may contribute to, or tend to prevent, serious
crash injuries. Some progress in the treatment of arthritis, atherosclerosis
and bursitis has been made and there is increasing hope of improvement in
our knowledge regarding their prevention.
North Carolina Board of Health 43
The Rural Health and Public Relations Committees have contributed in
a fundamental way in laying the groundwork for a better understanding
of, and a willingness and desire to proceed against, chronic disorders, and
accidents—just as was the case in earlier improved control of communica-ble
diseases. The work of the private practitioner will be just as ethical and
much more satisfying as all chronic disorders are promptly diagnosed and
control efforts are increased in effectiveness. Our state is in a strategic
position to lead the way in combating chronic disorders and accidents just
as private practitioners and the public health team joined hands to pioneer
in communicable disease control.
(For synopsis of departmental reports see THE HEALTH BULLETIN, issue June. 1955.1
44 Thirty-Sixth Biennial Report
STATE AND LOCAL HEALTH DEPARTMENT
SERVICES IN NORTH CAROLINA *
By J. W. R. Norton, M.D., M.P.H., F.A.C.P.**
Raleigh
Since so many know only part of the services of the state and local
health departments it seems appropriate to outline these so that we may
have more informed medical guidance in future program planning.
The state and local health departments in North Carolina have enjoyed a
growth in quality and quantity comparable to that of general hospitals
and private practice during the same period. This medical society was in
1877 and for two years the State Board of Health with an annual appro-priation
of $100.00 In 1879 a Board of nine, similar to that of today, was
set up. It was twenty-nine years later that a full-time physician was
employed. The fumigation, quarantine and the regulation-enforcement
emphasis era were as unsatisfactory in prevention as the similar groping
progress in private practice of the same period were in treatment.
The nine-member State Board of Health (five appointed by the Gov-ernor
and four by this Medical Society—six of these physicians) with
staggered four-year terms, formulate policies and prescribe regulations
and procedures that are carried out administratively through the 300 central
staff and 1200 local department employees.
The central staff organization is set up under the State Health Officer
and Assistant State Health Officer with six Division Directors and about
thirty section chiefs. The bare listing of titles suggests the programs and
services.
1. Central Administration includes budget, personnel, files, printing,
mailing and public relations.
2. The Epidemiology Division embraces sections as follows:—acute com-municable
diseases, public health statistics, venereal diseases, tuber-culosis,
occupational health, home and farm accident prevention, and
veterinary public health. Epidemiological consultations are increasing
in frequency and usefulness.
3. The Laboratory Division protects the public health through services
to private physicians, hospitals and health departments, through
biologies, microscopy, cultures, serology, water analyses, chemistry,
and approval of laboratories. The growing library should be of in-creasing
helpfulness to health staffs and private physicians.
4. The Local Health Division has sections as follows:—administrative,
public health nursing, mental health, health education, and (jointly
with the Education Department) school health.
5. The Oral Hygiene Division provides education through visual media,
lectures and literature and also services in consultation, correction
and prevention.
* Presented during Conjoint Session—Medical Society of North Carolina and Slate Board
of Health, Pinehurst. 2 May, 1956.
** Secretary-Treasurer of the State Board of Health and State Health Officer.
North Carolina Board of Health 45
G. The Personal Health Division includes the maternal and child health,
crippled children, nutrition, cancer, and heart disease sections.
7. The Sanitary Engineering Division includes four sections: sanitation,
(environmental, public eating places, milk, and shellfish), engineering,
insect and rodent control, and stream sanitation. Radio-active wastes,
air and stream sanitation and housing are of increasing importance.
Local health departments began in 1911, under the leadership of North
Carolina's first full-time health officer, Dr. Watson S. Rankin, and reached
the entire State in July, 1949. From the beginning there has been local
autonomy, flexibility and adaptability and medical guidance. Strong local
boards actively supported by the county medical society and public have
assured progressively better health services.
From the minimum of a health officer, public health nurse, sanitarian
and clerk (each full-time) and a ten-week oral hygiene program to a
large department such as Mecklenburg's (with about 150 workers, including
a full-time dentist) the services are provided mainly on the economical
generalized basis.
Local health department services may be briefly described under seven
headings:
1. Sanitation—The utmost in tact and leadership are required to assux-e
clean drinking water and milk and safe disposal of human wastes,
safe food processing and vending establishments and healthful schools
and camps. More should be done to protect our streams and the air
from contamination and to promote better housing for all, including
migratory farm laborers. Certain insects and rodents have depleted
food, clothing and shelter and spread epidemics and the health depart-ment
team wages war on those harmful to us. The approach is through
education and helpful leadership rather than authoritarian.
t/2. Good maternal-child hygiene begins with planned parenthood and
extends through prenatal, natal (including midwife supervision), post-natal,
infant, pre-school and school periods. Nutrition and oral hygiene
services are essential. Crippled childrens' services and rehabilitation
restore many to useful, happy lives. In this area we have reached
the best development as a cooperating team of private physicians,
hospitals and the public health staff and always including research and
teaching. Research indicates that a constructive maternal-child health
program will definitely reduce the incidence of mental defectives, juve-nile
delinquency and possibly some of the later neuroses, psychoses and
degenerative diseases. This is not too far back to go in planning a
preventive program in gerontology.
3. Communicable disease control is dependent on sanitation activities,
immunizations wherever available, and as in all other health progress
the cooperation between the public health team and the private prac-titioner-
hospital team is essential. Progress against the diarrheas,
dysenteries, smallpox, typhoid, tuberculosis, diphtheria, and malaria
shows what this coordinated effort can accomplish. Health workers
have had an important role in improving the treatment methods in
/
46 Thirty-Sixth Biennial Report
tuberculosis and venereal diseases and as a result many of these can
now be better treated in doctor's offices.
4. Laboratory services of the local health department assist in the clinic
programs and also aid the private physician. Prompt diagnostic aid
in commoner communicable diseases and in milk examinations are
examples.
Health education is the job of the entire staff under the stimulation
and leadership of those with special training in this field. All individual,
group, and mass audio-visual and other media are useful. The nurse
or sanitarian can give detailed instruction to supplement the brief
visits with, and to, the family physician. The health department can
inform the public regarding quackery and faddists and encourage
early supervision by the competent and ethical medical practitioner.
6. Public health statistics constitute the inventory, the income and the
outgo, of human resources. They may explain losses and point the
way to gains. They assist the private practitioner by alerting him in
diagnoses and point the way for teamwork in recognizing and com-batting
enemies of health and life. Sound evaluation and program
planning are impossible without accui'ate health bookkeeping.
7. Chronic diseases, mental disorders and accidents can be attacked
jointly by those in research and teaching, health departments and
private practitioners by the same methods proved useful before
against former common communicable diseases. Diseases of the heart
and blood vessels, cancer, mental disorders and accidents, are increasing
in our aging and hurried population. We have much to learn regarding
the etiology of mental disorders and the chronic degenerative diseases.
We have reason to believe early case-finding and medical guidance
with nurse follow-up can be useful in most cases. What part is played
by nutrition, endocrinology or viruses we hope to learn more about
soon. Health statistics are useful in identifying problems in these
areas and health departments can inform the public on the necessity
to cooperate in prevention and treatment.
Services of local and state health departments are so intertwined that
it may become difficult to distinguish them. Wherever direct services or
specialist consultation are not feasible through the local health depart-ment,
the state provides them.
Services of local health departments are recognized as the most impor-tant,
but any large business requires a reasonable overhead guiding and
cohesive force. Hence central administration, public health statistics and
laboratory services. Most local department personnel serve on a gener-alized
basis and, therefore, the state provides a few state or district
specialist consultants in such fields as sanitary engineering, nutrition,
laboratory activities, public health nursing and epidemiology. Direct
services to local health departments and private physicians are provided
in maternal and child health, crippled children, laboratory examinations
and supplying of biological products, oral hygiene, tuberculosis and ve-nereal
disease case-finding, accident (home and farm) prevention, and
North Carolina Board of Health 47
health education. Private physicians are also served through laboratory
aids, epidemiological consultation and statistical services and study com-mittees
of this Society through statistical, epidemologcal, and other serv-ces.
Many consultative health services are provided other state agencies
and institutions such as sanitary engineering, nutrition and food service
with the Medical Care Commission, Prison Department, Tuberculosis and
Mental Hospitals, and Training Schools. Consultation is provided munici-palities
regarding design and construction of water treatment and sewage
disposal plants. Materials used in the manufacture of bedding are inspected.
Insect and rodent control assists municipalities and industries. Occupa-tional
health activities protect workers and promote industrial develop-ment.
Veterinary public health services (working closely with the Agri-culture
Department) help control diseases which primarily attack animals
but secondarily man, and stimulate the livestock industry. Oral hygiene
has far-reaching effects in maternal and child health, reduces absenteeism
and probably reduces the degenerative diseases of our aging population.
Mental health services are being developed along lines similar to our
tuberculosis control work; namely, some central or district assistance in
case-finding and consultation and local health department instructional
guidance and follow-up. Public health has played a key part in the only
considerable reduction of mental disorders, in paresis and pellagra.
These many services provided by the state and local health departments
are helpful to all our four and a half million citizens and enhance the
attractiveness of private practice throughout our state. By preventing
disability and postponing death the standard of living is raised. The private
physician or dentist can be called earier when illness or injury does occur,
if the family has not previously been handicapped by preventable dis-abilities.
Agriculture and industry are stimulated and tourists are attracted
to come and to return. The people are becoming better informed on what
they may reasonably expect in prevention, diagnosis, treatment and re-habilitation
and if any area is neglected the public relations of every
physician and of organized medicine suffer accordingly.
The cost of these public health services is amazingly low. From a total
expenditure for fiscal 1955 of $8,007,917.44, or less than $2.00 per capita,
seventy per cent ($5,623,263.32) was used by local health departments.
Much of the remainder was invested in direct services or in consultation
services to local health departments, to other agencies and institutions
(state and local) and to private physicians and hospitals. For clinic and
corrective services private physicians were paid $240,202.78, and hospitals
received $548,253.42. Yet the per capita cost of local health services was
$1,385 with county-city appropriations providing 75%, and for state health
department services, the cost was $.587. The continuation of this ethical
teamwork of a sound and balanced preventive service, with emphasis on
economical decentralization, joined with progressive and unselfish private
practice offers our best promise of continuing our free enterprise system.
48 Thirty-Sixth Biennial Report
BIENNIAL REPORT
CENTRAL ADMINISTRATION
(July 1, 1954—June 30, 1956)
There were no important changes in the organization of the State Health
Department during the biennium beginning July 1, 1954, and ending June
30, 1956. Under the simplified form of organization which went into effect
February 1, 1950, the work of the Department continued to be carried on
smoothly and without any complications.
As the work in the Central Administration Division is carried on under
the direction of the Secretary and State Health Officer, the activities of
this Division are taken up first in this biennial report. Briefly, the following
Sections comprise the Central Administration Division: Budgets, Public
Relations, Central Files, Personnel, Mailing Room, Multilith, and Library.
Hence, the Secretary and State Health Officer not only is the executive
head of the State Health Department but a Division Director to whom the
Chiefs of the above named Sections are answerable. His office involves not
only executive and administrative duties, but also responsibilities of a
liaison nature. He maintains contact with other State Health Departments,
certain other agencies within the State, and with many officials engaged
in various activities which have any Public Health aspects. This means
that the work of the Secretary and State Health Officer has expanded
considerably during recent years, in which there are arisen a multiplicity
of voluntary agencies which concern themselves, either wholly or in part,
with health. It is the duty of the Secretary and State Health Officer not
only to familiarize himself with the programs and objectives of these
agencies, but to study their relationship to Public Health officially admin-istered.
In this connection, candor compels the statement that, in some cases,
outside organizations have shown a tendency to duplicate some of the
activities which the law places in the hands of Public Health officials.
However, no really serious difficulties have been experienced because of
this. Public Health, during the past biennium, as in former years, has
continued to administer the affairs legally committed to its charge, ignor-ing
any minor infringements which may have appeared in the entire
pattern.
HEALTH OFFICER'S ACTIVITIES:
First, a brief summary of the activities of the Secretary and State
Health Officer during the period covered in this report. He has been active
in his participation in the affairs of those organizations and groups with
which the North Carolina State Board of Health is affiliated. Under the
law

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Cfte If&rarp
of the
Dtottion of ptaub affairs
Ontoetieiitp of Jl^ortf? Carolina
Thirty-Sixth Biennial Report
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
JULY 1, 1954—JUNE 30, 1956
I
MEMBERS OF THE STATE BOARD OF HEALTH
Elected by the Medical Society of the State of North Carolina
G. Grady Dixon, M.D.,
Term expires 1959
John R. Bender, M.D.,
Term expires 1957
Ben J. Lawrence, M.D.,
Term expires 1957
G. Curtis Crump, M.D.,
Term expires 1959
Appointed by the Governor
A. C. Current, D.D.S.,
Term expires 1957
H. C. Lutz, Ph.G.,
Term expires 1959
Mrs. J. E. Latta,
Term expires 1957
John P. Henderson, Jr., M.D.,
Term expires 1959
* Lenox D. Baker, M.D.,
Term expires 1957
EXECUTIVE COMMITTEE
G. Grady Dixon, M.D., Chairman
Ben J. Lawrence, M.D., Vice President
John R. Bender, M.D.
J. \V. R. Norton, M.D., Secretary
EXECUTIVE STAFF AS OF JUNE 30, 1956
J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer
John H. Hamilton, M.D., Assistant Slate Health Officer and Director
Laboratory of Hygiene Division
Ernest A. Branch, D.D.S., Director Oral Hygiene Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
C. C. Applewhite, M.D., Director Local Health Division
A. H. Elliot, M.D., Director Personal Health Division
Fred T. Foard, M.D., Director Epidemiology Division
* Dr. Baker appointed to fill unexpired term of Dr. Hubert B. Haywood, who retired
January, 1956.
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LOCAL HEALTH OFFICERS IN
NORTH CAROLINA
N. C. State Board of Health, Local Health Division
Raleigh, N. C.
SEPTEMBER 28, 1956
DEPARTMENT
Madison
LETTER OF TRANSMITTAL
The Honorable Luther Hodges
Governor of North Carolina
The State Capitol
Raleigh, North Carolina
Dear Governor Hodges:
Pursuant to the provisions of Section 130-3, General Statutes of North
Carolina, I herewith submit to you, and through you, to the General
Assembly of North Carolina, the Biennial Report of the North Carolina
State Board of Health for the fiscal years of July 1, 1954-June 30, 1956.
Respectfully submitted
J. W. R. Norton, M.D.,
Secretary and State Health Officer
TABLE OF CONTENTS
Report of Secretary-Treasurer and State Health Officer 9
Chronic Diseases—A Joint Responsibility of
Private Practice and Public Health 41
State and Local Health Department Services in North Carolina 44
Central Administration 48
Personal Health Division 54
Local Health Division 68
Division of Epidemiology 02
Sanitary Engineering Division 110
State Laboratory of Hygiene 115
Division of Oral Hygiene 123
Report of Medico Legal Examinations Committee * • 127
REPORT OF THE SECRETARY-TREASURER
AND STATE HEALTH OFFICER
July 1, 1954—June 30, 1956
Abridged report of the activities of the State
Board of Health as recorded in the Minutes:
July 1, 1954. The first quarterly meeting of the North Carolina State
Board of Health for the biennium July 1, 1954-June 30, 1956, was held on
Thursday, July 1, 1954, at 10:30 a.m., in the auditorium of the State Labora-tory
of Hygiene Building, with President G. Grady Dixon, presiding. The
meeting was called to order by President Dixon.
Upon motion duly made and seconded, the Minutes of the May 5 meeting
were approved, without being read, since all members had previously re-ceived
a copy.
Dr. Hamilton made a further progress report regarding the Medical
Library, as to the lighting system, acoustics, painting and other repairs,
including a request to the Board of Buildings and Grounds for the privilege
of having the Library air-conditioned. This request has not been granted
so far. Dr. Hamilton also stated that Mr. John M. Gibson had been elected
Librarian, effective as of June 1, 1954. He comes from the Alabama Health
Department and was born at Gibson, North Carolina.
Dr. Hamilton and Mr. Jarrett discussed further progress on moving into
the new Cooper Memorial Health Building. Mr. Jarrett reported on plans,
length of time to move, etc., which he had discussed with the Transfer
Company. Dr. Hamilton said that the final inspection of the Building was
held on June 22 by the Board of Buildings and Grounds, architects, budget
engineers and others, and that the Building was accepted with the excep-tion
of the basement, the pent house and the heating tunnel and had now
been turned over to the Board of Buildings and Grounds which Board could
now have the telephones installed.
Secretary Norton reported on the N. C. Public Health Association meet-ing
which is to be held in Raleigh, September 23-25, 1954. The Board
discussed plans for the dedication of the Cooper Memorial Health Building,
time and place of a regular Board meeting at the time of the NCPHA
meeting, etc., but no decisions were made. The Board asked the Executive
Committee to work out, with the NCPHA, a definite program and advise
the members later.
Dr. C. C. Applewhite, Director, Local Health Division, was present and
discussed a suggested amendment to the Policies of the North Carolina
State Board of Health for Allocation of State Aid Funds to Local Health
Units, effective July 1, 1954. The additional paragraph related to the
employment of a part-time Health Officer, etc. It was moved by Mr. Lutz,
seconded by Mrs. Latta and unanimously carried, that the following para-graph
be inserted after the second paragraph in the policies governing
allocation of State Aid Funds to local health units:
10 Thirty-Sixth Biennial Report
"When any local health department is temporarily without the services
of a full-time health officer and it becomes necessary to employ a part-time
health officer, pending the selection of a full-time health officer meeting
Merit System qualifications, the salary of the part-time health officer shall
be determined on the percentage of full time spent in activities of the
health department. The maximum salary that may be paid the part-time
health officer shall not exceed one-half of the salary of a full-time health
officer having the same Merit System classification."
In a further discussion regarding bulk milk diespensers, Mr. Jarrett
presented some revised regulations governing the sanitation of restaurants,
summer camps and private institutions which were effected by the use of
the approved bulk milk dispensers. On motion of Dr. Lawrence, seconded
by Mrs. Latta, revisions to Section 6, Item 17 of the Law, Rules and Regu-lations
and Code Governing the Sanitation of Restaurants and Other Food
Handling Establishments, Section 7, Item 10 of the Law, Rules and Regu-lations
Governing the Sanitation of Summer Camps, Section 6, Item 16,
of the Law, Rules and Regulations and Code Governing the Sanitation of
Private Hospitals, Sanatoriums, Sanitariums and Education Institutions
are hereby amended in accordance with the action taken by the Board of
Health at its meeting in Pinehurst, N. C, May 5, 1954, which permitted
the use of approved bulk milk dispensers in those places desiring to use
them. Motion carried. (Copy of amendments filed in Minute Book)
Mr. Jarrett presented a request concerning the extension of the boundary
lines of the Roanoke Rapids Sanitary District and also the Town of Roanoke
Rapids. He stated that all documents had been carefully examined and
checked and that proper procedures had been followed in accordance with
requirements of the General Statutes for the extension of sanitary district
boundaries, and that he recommended favorable action by the Board. On
motion of Dr. Lawrence, seconded by Mr. Lutz, the resolutions approving
the extension of the boundary lines of the Roanoke Rapids Sanitary Dis-trict
in Halifax County and also the Town of Roanoke Rapids, were unani-mously
approved. (Copy filed in Minute Book)
Dr. Fred T. Foard, Director of the Division of Epidemiology gave a
very interesting and informative talk on the overall activities and accom-plishments
of the Division. He then introduced the seven Section Chiefs
in the Division, each of which has specific functions to perform in relation
to the control of disease or injury. These sections are: (1) Public Health
Statistics; (2) Communicable Disease Control; (3) Tuberculosis Control;
(4) Veterinary Public Health; (5) Industrial Hygiene; (6) Venereal Disease
Control; (7) Accident Prevention. In addition, the Division is conducting
a temporary study of crash automobile accidents in cooperation with the
State Motor Vehicles Department and sponsored by the Cornell University
Medical College and the Kellogg Foundation. Also, the Division is charged
with the collection of reports of narcotic addicts in North Carolina. Each
Section Chief presented a brief but concise report of the work in his re-spective
Section.
On the use of gamma globulin as polio preventive, Dr. Hamilton stated
that he had received a shipment of 95,000 cc. of gamma globulin for dis-tribution,
on request of Dr. Foard, as Director of Epidemiology.
North Carolina Board of Health 11
Dr. Foard stated that he is attempting- to recommend distribution of
gamma globulin to conform with recommendations of the National Foun-dation
for Infantile Paralysis, Inc.—that is, for use against polio only in
groups larger than single family groups. He stated that one shipment has
been sent out this year to Rockingham for use in treating neighborhood
contacts to an active case of polio, the diagnosis of which has been con-firmed
by staff at Duke University Hospital.
Miss Mae Reynolds, Budget Officer, presented and discussed briefly the
budgets for 1954-1955. Dr. Norton expressed appreciation to Miss Reynolds
for the excellent work she has done over the years and is doing as Budget
Officer.
Dr. Norton announced that he would be glad to have each one visit the
new Health Building offices and Library before leaving.
September 24, 1954.
The State Board of Health met in quarterly session in the Board Room,
in the Cooper Memorial Health Building, Friday afternoon, September 24
at 2:00 o'clock, Dr. G. Grady Dixon of Ayden, President, presiding. This
was the first regular meeting of the Board in the Cooper Memorial Health
Building which is the first State Health Office Building designed and con-structed
specifically for public health work in North Carolina.
Following the call to order, the Minutes of the previous session, held in
Raleigh, July 1, 1954, which had been circulated among the members, were
unanimously approved.
Dr. J. W. R. Norton, Secretary, then presented a progress report on
bulk milk dispensers. It was pointed out that the use of such dispensers
was approved by the State Board of Health, in session at Pinehurst, May 5,
1954. The State Board of Agriculture, in August, adopted a set of regula-tions
concerning the use of bulk milk dispensers which provided that the
amount dispensed should be no less than 8 fluid ounces, and that no milk
dispenser should be offered for sale or put into use in this State which was
not so built as to make possible the attachment of a measuring device.
Such a provision was not included in the regulations adopted by the State
Board of Health. The Board, advised of the regulations adopted by the
State Board of Agriculture, decided that further action on its part was
unnecessary at this time. Mr. John Andrews, Chief of the Sanitation Sec-tion,
served on a committee advising with the Board of Agriculture in
drawing up its regulations.
The Board then took up the question of issuing an order for the town of
Pembroke to construct a sewage treatment plant. Mr. William McKimmon
explained the matter briefly and concisely. Upon motion of Dr. Lawrence,
seconded by Dr. Henderson, a resolution was adopted ordering the town of
Pembroke to construct a new sewage treatment plant and necessary appur-tenances.
(Copy of Order filed in Minute Book)
The Board heard a report on the revised Communicable Disease Regula-tion
40, relating to Psittacosis, copies of which had been sent to each Board
member several days previously. The matter was presented by Dr. Fred T.
Foard and explained by Dr. Martin P. Hines, Chief of the Veterinary
Public Health section of the Division of Epidemiology. He advised the
12 Thirty-Sixth Biennial Report
Board that, although there is no provision for paying an indemnity to
merchants whose birds are confiscated and killed when suspected of having
psittacosis, Mr. Ralph Moody, Assistant Attorney General, had assured
him that the department of the Attorney General would stand back of the
State Board of Health in the enforcement of the amended regulation for
the control of psittacosis. (Copy of Revision of Communicable Disease
Regulation 40 Relating to Psittacosis filed in Minute Book)
It was pointed out that, while it was the intention of the General
Assembly that the new Health Building should be named the George
Marion Cooper Memorial Health Building, Chapter 76 authorized the State
Board of Health to do so,—making ratification necessary on the part of the
Board. Upon motion of Dr. Lawrence, seconded by Dr. Henderson, the
Board unanimously passed the following resolution:
"That, in conformity with Chapter 76 of the 1951 Session Laws, ratified
on the 20th day of February, 1951, we do hereby name the new Health
Building on North McDowell Street, the George Marion Cooper Memorial
Health Building."
Following the above order of business, Dr. E. A. Branch, Director of the
Oral Hygiene Division, appeared before the Board with visual demonstra-tions
of the objectives and accomplishments of his Division. While Dr.
Branch's appearance called for no official action on the part of the Board,
those present unanimously expressed their approval of his efforts and
their appreciation of the work that he and his staff have accomplished in
behalf of the school children of North Carolina. Dr. Branch emphasized
the difficulty of obtaining adequate personnel for the administration of
the State's Oral Hygiene program. While there seemed no answer, at
present, to this dilemma, the hope was expressed that, through a continu-ation
of effort, including education, young dentists yet may be prevailed
upon to fill the vacancies in which they can render great service to the
children of North Carolina.
The Board adjourned to attend a reception at the Executive Mansion,
complimentary to the members of the North Carolina Public Health Asso-ciation,
assembled in Raleigh for their 43rd annual meeting.
January 25, 1955.
The North Carolina State Board of Health met in regular quarterly
session, Tuesday, January 25, 1955, at 10:00 a.m. in the Board Room of the
Cooper Memorial Health Building, with President Dixon presiding. The
meeting was called to order by President Dixon.
Minutes of the Board meeting held on September 24, 1954, were approved
as circulated to the members of the Board by the Secretary.
Secretary Norton gave a bi'ief report on the conference of local health
officers held on January 18th. He stated that the attendance was good and
a number of subjects were discussed informally pertaining to matters of
current interest to the health officers regarding the budget for the next
biennium, proposed legislation, and the polio vaccine (Salk). Also, the
Secretary made a report on the Cancer Survey and Dr. Hamilton and Mr.
John M. Gibson gave a progress report on the Library. Honorable Luther
H. Hodges, Governor of North Carolina, appeared before the local health
North Carolina Board of Health 13
officers at 2:30 at their afternoon session, and gave them a very interesting
and stimulating talk on public health, praising the work they were doing
and complimenting them on the distinctive and worthwhile service being
accomplished in the State.
At this point, Governor Hodges honored the Board of Health with a visit.
He was presented by President Dixon, who expressed his appreciation that
the Governor had accepted Secretary Norton's invitation to be present at
the Board meeting on this occasion. The Governor stated that he was very
happy to be present, that he was trying to see as many of the important
boards as possible, and that he certainly would include the Board of Health
of North Carolina as one of these; that he has known of the work of the
State Board of Health since he was a young man. "I think," he continued,
"you are the kind of dedicated people who do a great humanitarian job."
He repeated a statement made to the local health officers, when he declared
that if each would spend the state money as though he was paying for the
job himself, he would get an additional thrill at the end of each day's work.
The Governor discussed the current state budget and said he recently
startled a group by declaring that North Carolina, within a few years,
will be a billion dollar state when funds from all sources are counted.
"Health and education," he stated, "must move with our population growth.
In these fields, we must recognize and meet the problems of our new
children. As we move forward in big figures, we must also move along in
our services to the people." He said, in conclusion: "I bring you greetings
and thank you and the others, in the name of North Carolina, for the
services rendered." Dr. Dixon thanked the Governor for his visit.
At the conclusion of Governor Hodges' address, it was pointed out that
this was the first time within the recollection of anyone present that a
Governor had attended a meeting of the Board. In view of this, Dr. Ben J.
Lawrence moved that the Board adopt a resolution, expressing appreciation
not only of Governor Hodges' visit, but of his remarks, in which he ex-pressed
appreciation for public health work in North Carolina and called
for a vededication to the service of humanity, and that a copy be sent to
the Governor and also spread on the Minutes of the Board. Motion was
seconded by Dr. Crump and carried unanimously.
Dr. Charles M. Cameron of the Epidemiology Division, made photographs
of the Board with the Governor. Dr. John Bender asked that a copy be
sent to each member and also that the Board go on record as expressing
appreciation for Dr. Cameron's services.
Dr. Dixon mentioned the regrettable accident of Miss Mae Reynolds,
the budget officer, who had the misfortune of falling on the snow anil frac-turing
a hip. A note expressing the Board's deep appreciation for her
faithful services and wishing for her a speedy and uneventful recovery
was signed by each and forwarded to her,—in addition to flowers.
Dr. B. M. Drake of the Local Health Division, in which the School Health
Coordinating Service is lodged, had prepared a brief report on this joint
Service with the Education Department. There were discussions by Doctors
Hamilton, Applewhite and Branch, but no action taken. Secretary Norton
stated that the School Health Work was also being studied by an Advisory
14 Thirty-Sixth Biennial Report
Committee from the Medical Society and the State Dental Society and
that they may have a report to make in the near future.
Dr. Hamilton gave a report on the progress of the Medical Examiner
Bill which is to be introduced in the General Assembly, a copy of which
has been sent to each member of the Board, and to be known as A BILL
TO BE ENTITLED AN ACT TO REVISE THE LAWS OF NORTH
CAROLINA WITH RESPECT TO POSTMORTEM MEDICOLEGAL EX-AMINATIONS.
Dr. Cameron brought greetings from Dr. Foard, the Director of the
Epidemiology Division, who was delayed. He also discussed tentative
items of proposed legislation which might be brought up before the General
Assembly, but on which no immediate action was required by the Board,
namely: (a) the disposal of abandoned ice boxes and refrigerators; (b)
amendments to existing vital statistics laws, and (c) revision in the State's
enabling act relative to the rabies program.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was
present and discussed a petition which would create a sanitary district in
McDowell County. He stated that various transactions and documents had
been examined by his office, and, in their opinion, were in order. He, there-fore,
recommended that the Board create the proposed district. Dr. Bender
moved that the resolution creating the District to be known as the East
Marion Sanitary District, be adopted. Motion was seconded by Dr. Crump
and unanimously carried. (Copy of resolution filed in Minute Book)
Mr. Jarrett also discussed an order for Farmville, to install adequate
sewage treatment facilities and sewer extensions. He recommended favor'
able action by the Board on this resolution, stating that all documents and
transactions had been examined and found in order by his office. On motion
of Dr. Current, seconded by Dr. Henderson, the resolution ordering the
Town of Farmville to make necessary sewerage improvements was carried.
(Copy of resolution filed in Minute Book)
A resolution ordering the Town of Woodland to install an adequate
sewage collecting system and sewage treatment facilities was presented
and discussed by Mr. Jarrett. He also recommended favorable action by
the Board on this resolution. On motion of Dr. Current, seconded by Dr.
Lawrence, the resolution ordering the Town of Woodland to make necessary
sewerage improvements, was carried. (Copy of resolution filed in Minute
Book)
Mr. Jarrett again discussed the bulk milk dispenser regulations and
presented a revision, or insert, to Item 17 of Restaurant Sanitation Regu-lations
as follows:
"; provided further, that in the case of restaurants and hotels having
several banquet halls and dining rooms served from a central kitchen, if
careful investigation proves it impractical to locate the milk dispenser in a
dining room because of established food checking and serving routines, the
milk dispenser may be installed in the food serving area of the kitchen in a
location specifically approved by the local health officer and the label infor-mation
required by this item shall be shown prominently on the menu cards
instead of on the milk dispenser cabinet."
North Carolina Board of Health 15
On motion of Dr. Current, seconded by Dr. Bender, this amendment was
approved.
Secretary Norton discussed possible revision of the law to change the
title of Secretary and State Health Officer. It was the consensus that this
matter should be discussed with the Attorney General as to how far-reaching
this change would be and what effect on regulations and what
change it would make in this Board, if any.
The meeting was declared adjourned at 1:10 p.m. to meet at 2:00 p.m.
in the Revenue Building to appear at the hearing before the Joint Appro-priations
Committee.
May 4, 1955. The State Board of Health met in the Dutch Room of the
Carolina Hotel in Pinehurst, Wednesday, May 4, at 1:30 p.m., Dr. G. Grady
Dixon, the President, presiding.
The meeting was called to order. On motion duly made and seconded,
the minutes of the January 25, 1955 Board meeting were approved without
being read since members had previously received copies.
The first matter taken up was that concerning pending actions in the
field of Sanitary Engineering, with an explanation of each by Mr. J. M.
Jarrett, Director of the Sanitary Engineering Division. The first item was
a recommendation for the creation of what is known as the Rutherford
College Sanitary District. A delegation from the district was present to
hear the discussion, if any, pertaining to this matter. After the Board had
heard Mr. Jarrett's explanation, Dr. Current moved that the district be
created and his motion was seconded by Dr. Haywood. Affirmative action
was unanimous. (Copy of resolution filed in Minute Book)
Mr. Jarrett next presented a proposed ordinance which would, in effect,
permit fishing in Lake Benson in Raleigh, along with Lakes Raleigh and
Johnson, in the City's water supply system. On motion of Dr. Haywood,
seconded by Dr. Henderson, this was approved, as requested by the gov-erning
body of the City of Raleigh. (Copy of Resolution filed in Minute
Book)
Action on a third item, namely, a revision of regulations regarding sub-mission
of plans for water and sewerage systems, was deferred until a
subsequent meeting, at which time the matter will be explained by Mr.
Jarrett, who stated that some of the present regulations are outmoded.
Dr. Norton called the Board's attention to the manner in which money is
raised for agencies and suggested that Board members be giving this
matter attention and consideration and discussion at a future meeting in
regard to such funds. Dr. Norton made particular reference to percentages
sent out of the State and amounts spent within North Carolina and by the
local communities. Upon motion of Dr. Crump, seconded by Dr. Current,
it was agreed that the matter of fund raising and national, state and local
sharing be taken up and given thorough consideration at an early meeting
of the Board.
Dr. Norton then called attention to the method in which complaints
reaching his office are handled. He gave one specific example and informed
the Board that every complaint coming to his desk was investigated and
that the complainant was given the results of findings. Some complaints,
16 Thirty-Sixth Biennial Report
he said, are justified and some are not, but this, in his opinion, does not
relieve his office of its responsibility to look into all matters pertaining to
health in North Carolina.
The next item on the agenda involved a report by Dr. Norton on pending
State and national legislation affecting Public Health. He called attention
to the fact that he shared the view of leading health officials—such as Dr.
Hilleboe of New York— that the distribution of the Salk vaccine should be
on a voluntary control basis. He said that, in his opinion, controls involving
legislation will cause confusion and delay, while he thought that voluntary
control would assure better results. He pointed out the fact that, at a
Conjoint Session of the Board and the State Medical Society, a few minutes
prior to the Board meeting, a resolution favoring voluntary, rather than
stringent governmental control, was adopted.
Dr. Norton called the Board's attention to a telephone message, in which
Mr. David S. Coltrane had informed him of a proposed change in the
$550,000 School Health Appropriation Bill substituting the word "profes-sional"
for "medical and dental." He said that action, in his opinion, would
let down the bars for practitioners of various kinds outside the realm of
medicine and dentistry. He stated that without the retention of the word
"medicine" it would be best to return to the single line item as before.
Upon motion of Dr. Current, seconded by Dr. Crump, the Board went on
record as insisting upon the retention of the word "medical" in the appro-priations
measure above referred to.
The next item on the agenda called for discussion with a view to clarify-ing
policies of the North Carolina State Board of Health for the allocation
of funds to local health departments. Dr. C. C. Applewhite stated that under
the present system it is often impossible to employ competent personnel.
He stated that he wished to bring the matter to the Board's attention at
this time because local budgets now are being prepared. Dr. Current moved,
Dr. Crump seconded, and the Board passed the amendment.
Dr. Lawrence proposed that at a later meeting when the matter could
be handled in an unhurried way there should be thought, discussion, and
appropriate action on outside influences in the employment of personnel.
It was so agreed and Mrs. Kneedler will be asked to be present for that
meeting.
Dr. Norton called attention to the fact that his term as State Health
Officer and that of Dr. John H. Hamilton, as Assistant State Health Officer,
will expire this year, but indicated he did not think the Board had time to
go into this matter at this limited session, which had to be concluded at
2:15 p.m. President Dixon stated that the re-election of Dr. Norton and
Dr. Hamilton was merely a formality and could be disposed of without loss
of time. Dr. Haywood moved the re-election of Dr. Norton and Dr. Hamil-ton,
seconded by Dr. Current. Dr. Dixon made the observation that no
motion really was necessary, as the Board was unanimous in this matter.
Dr. Norton and Dr. Hamilton were re-elected for four year terms beginning
July 1, 1955, by acclamation.
The President is to write a letter to Governor Hodges notifying him
officially of the Board's action. (Governor Hodges was officially notified on
North Carolina Board of Health 17
May G and his letter of confirmation was duly received on May 11, 1955).
June 30, 1955. The North Carolina State Board of Health met in regular
quarterly session, Thursday, June 30, 1955. The Board went first to the
office of Governor Luther H. Hodges, in the Capitol, where at 9:30 a.m.,
Associate Justice R. Hunt Parker, of the North Cai'olina Supreme Court,
administered the Oaths of Office to the following, for four-year terms,
expiring May, 1959:
Governor Hodges' Appointees: H. C. Lutz, Ph.G., Hickory — (Re-appointed)
; John P. Henderson, Jr., M.D., Sneads Ferry — (Re-appointed).
Elected by the North Carolina Medical Society: G. Grady Dixon, M.D.,
Ayden — (Re-elected); G. Curtis Crump, M.D., Asheville — (Re-elected).
Following the exercises in the Governor's Office, the Board went into
regular session in the Board Room in the Cooper Memorial Health Building.
The meeting was called to order by Vice-President, Dr. Hubert B. Haywood.
On motion of Dr. Current, seconded by several members, Dr. Dixon was
unanimously re-elected to serve another term as President of the State
Board of Health, and he took the chair.
Minutes of the Board meeting held on May 4, 1955, were approved,
without being read, as copies had been circulated to each member.
Secretary Norton gave an informative report with regard to national
health programs for which there is solicitation in the State in relation to
percentage of collections retained and sent out of the State. He pointed out
the percentages governing the division of funds raised in campaigns in
North Carolina by the twelve State branches of large national health
organizations operating in this State such as: the North Carolina Division,
American Cancer Society; North Carolina Heart Association; North Caro-lina
Society for Crippled Children and Adults; North Carolina Tuberculosis
Association; National Federation for Infantile Paralysis; Muscular Dys-trophy
Association of America; United Cerebral Palsy Association of
North Carolina; National Multiple Sclerosis Society; Arthritis and Rheu-matism
Foundation; National Association for Mental Health; National
Jewish Hospital at Denver; Sister Elizabeth Kenny Foundation. There was
no action taken but it was suggested that a copy of this chart be furnished
each Board member for study and information. Several expressed an opin-ion
that too large an amount goes to national organizations and very little
is retained in the State and particularly locally.
Dr. C. C. Applewhite, Director of the Local Health Division, and Mis.
.Mary King Kneedler, Chief, Public Health Nursing Section, were present.
Dr. Applewhite made an informative report regarding possible outside
influences in the employment of personnel. In the discussion. Dr. Apple-white
took the position that since the Board of Health is under the Merit
System and State Personnel Department, it has to follow the rules and
regulations and policies of these official agencies, and that even good genera]
rules may, in extremely rare cases, become an individual hardship.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was
present and presented a request for a Sanitary District to be created and
to be known as the "Enon Sanitary District" in Burke County. Mr. Jarrett
stated that all documents and transactions had been carefully examined
18 Thirty-Sixth Biennial Report
by his Division, and were in order for the creation of the District. At this
point, Mr. Jarrett introduced Mr. W. T. Joyner, Jr., Attorney for the
Southern Railway, who had requested an opportunity to appear before
the Board. Mr. Joyner objected to the Sanitary District including the right-of-
way of the Southern Railway. The railroad has no objections to being
included in the District, provided its lines were not included simply for tax
purposes, he said. After discussion by Mr. Joyner and members of the
Board, it was decided that action regarding the formation of the District
be deferred until the boundary line could be established. Since it was
brought out during the discussion that approximately thirty-three houses
outside of the proposed District were to be served by the Sanitary District,
the question was raised as to whether or not it might be best to include
them within the District at this time.
Mr. Jarrett also presented a request from the Town of Claremont, North
Carolina, asking that the State Board of Health issue an Order making it
mandatory that the Town install a sewerage system and sewage treatment
plant. He stated that all documents had been carefully examined and
checked and that proper procedures had been followed in accordance with
the requirements of the General Statutes. On motion of Dr. Current, sec-onded
by Mrs. Latta, the Order for the Town of Claremont to install
adequate and necessary treatment facilities, was unanimously carried.
Mr. Jarrett then reported informatively on the use of iodophors for the
bactericidal treatment of milk and food utensils and equipment. It was
brought out that if approval was given, our present sanitary regulations
would have to be amended. After much discussion, the approval of the use
of iodophors was deferred.
Dr. A. H. Elliot, Director of the Personal Health Division, appeared
before the Board, on invitation from Secretary Norton, to explain the
result of a conference with regard to re-licensing the Muscular Dystrophy
Association of America. The problem involved was one of complaint within
the State that local funds appeared not to be readily available for muscular
dystrophy patients in localities in which funds had been raised. Dr. Ellen
Winston's office desires the support of the State Board of Health in with-holding
any re-licensing until she has assurance that funds would be dis-pensed
within the State, according to national regulations. No action was
taken, as this report was for the Board's information.
Dr. John H. Hamilton, Assistant State Health Officer, and Dr. Fred T.
Foard, Director of the Division of Epidemiology, both just back from a
conference in Washington, reported on proposed plans for the distribution
of Salk polio vaccine, after the contractual obligations of the National
Foundation for Infantile Paralysis have been fulfilled. There was a general
and informal discussion of various angles of the vaccine situation, but no
action was taken.
Secretary Norton reported to the Board on his trip to the Eighth World
Health Assembly, in Mexico City, May 10-28, 1955, which he said was most
informative and stimulating.
September 23, 1955. A meeting of the North Carolina State Board of
Health was held at the Robert E. Lee Hotel, Winston-Salem, Friday, Sep-
North Carolina Board of Health 19
tcmber 23, 1955, 2:30-5:00 p.m., at the time and place of meeting of the
44th Annual Session of the North Carolina Public Health Association.
Board members and their wives (or husband) were invited guests of the
Association at the annual banquet and dance on Friday evening.
The Board meeting was called to order by President Dixon. The minutes
of the Board meeting held on June 30, 1955, were approved without being
read since all members had previously received a copy.
Secretary Norton made a progress report and presented a chart or table
showing the amount of funds raised and available to North Carolina by
certain national health organizations soliciting funds in the State. There
was much discussion on the subject and it was the consensus that a further
study should be made of these funds; that Dr. Norton provide the same
information to the Executive Council of the State Medical Society on
Sunday, September 25th, and also to secure further information and a
breakdown of the use of the funds from the State Welfare Department
for overhead, and what percentages are actually used for protective service.
Dr. Eugene A. Gillis, Regional Director, Department of HEW, Public
Health Service, Region III, Washington, D. C. was present. He was called
on from time to time to give information from the Public Health Service's
viewpoint.
Dr. Fred T. Foard, Director of the Division of Epidemiology, was present
and presented a progress report relative to poliomyelitis vaccine. He dis-cussed,
in detail, information as to the apportionment of vaccine for public
health agencies, the administration of the vaccine, etc., and stated that
"all local health departments will be inquired under provision of the Federal
law to administer vaccine in clinics free of charge, without a "means test,"
and no child will be refused vaccine by local health departments." Also,
carefully prepared charts, questions and answers giving information and
procedures regarding poliomyelitis vaccine had been prepared and was
presented to each Board member. There was much discussion of the State
plan for distributing and administering the vaccine but no action was taken
by the Board for changing the plan as submitted to and approved
by the U. S. Public Health Service.
Dr. John H. Hamilton, Assistant State Health Officer, was present and
discussed progress made on the recodification of public health laws and
regulations of the State Board of Health which are being rewritten and
revised to delete obsolete provisions and eliminate confusion. A study
of the present laws and regulations was started about six months ago by
the Institute of Government at Chapel Hill. Preliminary drafts of the
revised code will be prepared and a progress report made to the Board
later. After the adopted revisions have been approved by the Board, the
recommendations will be presented to the 1957 General Assembly. On
motion of Dr. Crump, seconded by Dr. Current, the following terminology
was suggested to be used:
(a) That the term "Board of Health" refer to the membership of the
Board.
(b) That term "Department of Health" or "Health Department" refer
to the administrative offices of the Board.
20 Thirty-Sixth Biennial Report
(c) That the term "Commissioner of Health" or "Health Commissioner"
be used instead of the present "Secretary-Treasurer and State
Health Officer."
(d) That the title of Assistant State Health Officer be changed to
"Deputy Commissioner of Health" or "Deputy Health Commissioner."
(e) That the Bureau of Vital Statistics be changed to "Vital Statistics
Office."
Motion carried unanimously.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, dis-cussed
further the Enon Sanitary District in Burke County which was
before the Board at its meeting on June 30th. In presenting the resolution
creating the Enon Sanitary District, Mr. Jarrett explained the corrections
which had been made in the boundaries of the district as originally pro-posed
which allowed for the inclusion of additional homes and also reduced
somewhat the total area involved, and recommended that the district be
created. Dr. Crump moved that the resolution creating the Enon Sanitary
Latta and unanimously carried. (Copy of resolution filed in Minute Book)
District in Burke County as revised be adopted. Motion seconded by Mrs.
Mr. Jarrett again discussed the question of acceptance of iodophores as
bactericidal agents for use in restaurants and dairies, and after further
study, he recommended the approval of the use of iodophores. Dr. Current
moved that the State Board of Health accept iodophores as a bactericidal
agent. Motion seconded by Dr. Crump, and carried.
Mr. Jarrett also discussed the construction of a raw water reservoir
as a standby storage for the Town of Reidsville. He presented a description
of the proposed reservoir site and also discussed the problem of stock
watering by the property owners. Mr. Jarrett stated that special in-vestigations
had been made of this problem and he recommended that the
watershed regulations for the protection of filtered surface water supplies
be amended to read as follows:
Section 5 of Watershed Regulations For the Protection of Filtered
Surface Water Supplies—"The habitual watering, washing, or wallowing
of any horses, mules, cattle, hogs, sheep, goats or any large animals shall
not be permitted in or along the margin of any water supply reservoir,
pond or lake; except, in cases where very large volumes of water are in-volved
and the State Board of Health determines, after a thorough investi-gation,
that the quality of the water, in the opinion of the Board, will
not be adversely affected so as to render it unsatisfactory for use as a
public water supply. The habitual washing or wallowing of any horses,
mules, cattle, hogs, sheep, goats or any large animals shall not be per-mitted
on unimpounded streams which are tributary to the public water
supply within a distance of 5 miles above the waterworks intake. The
above shall not prohibit the watering of domestic animals from tributary
streams on farms which may be located on the watershed." On motion of
Dr. Current, seconded by Dr. Bender, the above amendment to Section 5
of the watershed regulations for the protection of filtered surface water
supplies was unanimously adopted.
North Carolina Board of Health 21
Mr. Jarrett then presented and discussed the revised regulations govern-ing
the sanitation of restaurants and other foodhandling establishments
which had been circulated to the Board members for information and
study. He stated that these revisions became necessary because of changes
in the hotel and cafe laws made by the 1955 General Assmbly. After dis-cussion,
on motion of Dr. Current, seconded by Dr. Crump, the revised
regulations governing the sanitation of restaurants and other foodhandling
establishments, as amended, were adopted unanimously. (Copy filed in
Minute Book)
Secretary Norton reported a number of items of interest to the Board
members such as the efficiency of self-operated elevators which are now
being used in the building and of the damage which has been done to the
building by the hurricanes. Air conditioning of the building was also dis-cussed,
and on motion of Dr. Crump, seconded by Dr. Henderson, it was
suggested that a letter be written to Mr. George B. Cherry, Superintendent
of Buildings and Grounds, urging that air conditioning be installed just as
soon as practical. Motion unanimously carried.
Also, in making his report, Dr. Norton told the Board about losing
key employees, secretaries and clerks due to inability or delay in actions
by the State Personnel Department. After discussion, it was the consensus
that Secretary Norton draft a letter to the Governor for signature by Dr.
Dixon, as President of the Board, apprising him of the situation that has
come up in being unable to employ or reclassify qualified personnel be-cause
of obstruction by the State Personnel Department.
January 12, 1956. A regular quarterly meeting of the North Carolina
State Board of Health was held on Thursday, January 12, 1956, 10:00—
12:00 noon and 1:00 p.m.—3:30 p.m., in the Board Room, Cooper Memorial
Health Building, with President G. Grady Dixon, presiding.
Dr. Crump and Dr. Henderson notified Dr. Norton by telegrams that it
would be impossible for them to be present.
The meeting was called to order by the President, Dr. Dixon.
On Motion of Dr. Current, seconded by Dr. Haywood, the minutes of
the meeting held on September 23, 1955, were approved without being
read since all members had previously received a copy.
Dr. Norton reported on the Cornell Crash Injury study. He said the
study has progressed to the point that the Ford and Chrysler motor com-panies
have given $200,000 each for its continuation which is under the
general supervision of Cornell University. The approval of the Executive
Council of the Medical Society of the State of North Carolina has been
given for its continuation for the next two years. The principal results
of the study have been improvement in the type of steering wheel, so
that the steering post does not crash into the chest; locking doors so that
the doors will not fly open; padding for the instrument panel and visors,
and shatter-proof rear view mirrors. The material in the padding is a
material that absorbs shock about five times as well as foam rubber. North
Carolina was the pioneer State, and has been given recognition in the
reports on the study. A representative from Cornell, at a meeting with
22 Thirty-Sixth Biennial Report
Dr. Norton, agreed to provide reimbursement for one additional person
(clerk) in Vital Statistics and postage and materials of about $500.00.
Dr. Norton recommended that Board approval be given to continuing
the study for two years. Dr. Lawrence moved, seconded by Mr. Lutz, that
the Board approve continuation of the Cornell Crash Injury study for a
period of two years. Passage was unanimous.
Mrs. Isabelle R. Henderson, Chief of the Personnel Section, made a
report on the major personnel problems of the State Board of Health,
including those not solved satisfactorily by the State Personnel Depart-ment,
dating back to June, 1952; appeals to the State Personnel Council;
separations for better pay with other governmental agencies, and vacant
positions to be filled in the State Board of Health as of January 12, 1956.
Mrs. Henderson answered several questions asked by members of the Board.
Dr. Dixon recognized Dr. James P. Rousseau of Winston-Salem, Presi-dent,
and Mr. James T. Barnes, Executive Secretary of the State Medical
Society, inviting them to join in any of the discussions.
Dr. Fred T. Foard, Director of the Division of Epidemiology, made a
report on the distribution of the Salk polio vaccine and gave each Board
member copies of recent correspondence. There are 160,251 ccs. of vaccine
in the 70% allocation on hand at the manufacturers, which have not been
distributed Dr. Foard said. The larger health departments do not have
enough to inaugurate mass programs and are, therefore, giving it only at
health centers. Dr. Foard has asked every county not putting on a mass
program to make available any vaccine they cannot use, to other counties.
This is being done, he reported, and the demand is greater than the supply
in the 30% allocation. There are 900,000 children in the State eligible for
the vaccine and only 490,287 ccs. have been released, according to informa-tion
in hand. Three doses are necessary for each child. 187,125 ccs. have
been reported as sold to private physicians.
Dr. Rousseau said he felt that there is a great lack of demand for vac-cine,
due to absence of proper educational programs to the public; and
the unused vaccine in private channels, he feels, would be used, if an
educational program were promoted. Such a program has been started
and is on the radio and television, telling the people what the health
officers and medical profession feel about the value of vaccine and why
they should have their children immunized now before polio season comes.
This should increase the demand for vaccine. "If the health departments
run a shortage, I think the Medical Society is perfectly willing for them
to buy the extra amount that they need. My personal feeling is that the
vaccine should be distributed over the State as originally outlined—30-70
percent—but exceptions should be made," Dr. Rousseau said. A re-edu-cational
program is needed, because the first great enthusiasm was killed.
Dr. Norton stated that the State Board of Health has no authority
from either the Board or from the Governor's Advisory Committee to
purchase vaccine released through commercial channels at this time.
Dr. Foard suggested that the ratio be changed to 50-50.
Dr. Current made the point that any citizen in North Carolina can go
to the Public Health Department for any kind of immunization, if he so
North Carolina Board of Health 23
desires, and we should work as rapidly as we can toward bringing polio
vaccine into the same category as other immunizing agents.
Dr. Dixon recommended that Dr. Foard's office get out a letter to every
physician in the State, stating that the use of polio vaccine is approved
by the State Board of Health to be administered to any and all children
or people; that the State Board of Health advocates, recommends, or
suggests that they get those in their practice immunized before May;
that the vaccine is available to them through commercial houses. A
letter like that might make some of the doctors begin to think, Dr. Dixon
said. Another suggestion was that the State Board of Health buy an
extra ten or twenty percent at the present time, in order to get it to
the other people, with the approval of the Governor's Advisory Committee.
Dr. Foard proposed that the State Board of Health buy all the available
vaccine and furnish it, free, through local health departments, to all
physicians requesting it, with the understanding that they make no charge
for that vaccine but any charge deemed proper for administering it. Dr.
Rousseau said he thought the medical profession would object to Dr. Foard's
proposal that vaccine be provided free.
Dr. Bender moved, "that the State Board of Health go on record as
recommending to the North Carolina Advisory Committee on Poliomyelitis
Vaccine that the backlog of 160,251 ccs. of vaccine which is part of the
70 9£ allocation to commercial channels for this State and now in the hands
of the manufacturers and not being called for by wholesale druggists or
private physicians in the State, be made available for purchase by the
State Board of Health for distribution to local health departments." Dr.
Lawrence amended this motion and it was accepted by Dr. Bender,—"pro-vided,
that such parts of this vaccine as requested and needed by private
physicians for their own private patients, be made available to them at
no cost for the vaccine as long as it is available." Motion seconded by Mrs.
Latta as amended, and carried without dissent.
Dr. Rousseau said that he did not think the medical profession could
object to free vaccine, if they were at liberty to make a charge for ad-ministration.
Dr. Haywood stated that as he has been on the Board 23 years, is in
bad health and has been retired from active practice for two years, it was
his intention to offer his resignation to the Governor. He submitted a list
of suggestions which, he said, might simplify and enhance the Board's
efficient deliberations. (Recommendations filed in Minute Book)
Dr. Lawrence expressed the hope that Dr. Haywood would delay his
resignation for a little while, till the completion of his present term (May,
1957) if not a hazard to his health. Dr. Dixon said it was his opinion Dr.
Haywood has done as much as, or more than, any other member of the
Board of Health, or any member of the State Medical Society to promote
the public and general health and welfare, or any other man in the whole
State of North Carolina.
Mr. Jarrett suggested and recommended a substitute resolution, repealing
the resolution adopted at the last meeting, with reference to the Enon
Sanitary District. Mr. Byrd, a lawyer representing the district, was pre-
24 Thirty-Sixth Biennial Report
sent, and explained the legal technicality which made it necessary to change
the sanitary district. Discussion was postponed until the afternoon session,
and the meeting was adjourned for lunch at 12:30 p.m.
The afternoon session was called to order at 1:30 p.m. The first item
brought before the Board was the suggested change in the fluoridation
policy. Mr. Jarrett requested that Section IV, paragraph 7, of the fluorida-tion
policy be amended by changing the word "shall" in the second line
to "should" and adding the following sentence at the end of the paragraph:
"Where tinted or colored fluoride chemicals are not available, white
fluoride may be used, provided every necessary precaution is taken to in-sure
its proper handling and use." This would make the paragraph read
as follows:
"The fluoride chemical shall be plainly labeled and, if in dry form, should
be colored by means of a dye in order that it may be readily distinguished
from other chemicals used in water treatment processes. The dye used for
this purpose when applied to the water so as to add 1.5 p. p.m. of fluoride
(F), shall not in any way be toxic or detrimental to health and shall not
in any way effect the quality of the water in respect to the U. S. Public
Health Service Standards. The kind of coloring material used for coloring
the fluoride shall be identified by the manufacturer in his proposal. Where
tinted or colored fluoride chemicals are not available, white fluoride may
be used, provided every necessary precaution is taken to insure its proper
handling and use."
Dr. Bender moved that the policy be changed according to Mr. Jarrett's
recommendation. Mr. Lutz seconded the motion and it carried without
objection.
Dr. Lawrence moved that Mr. Jarrett's recommendation with regai'd
to the Enon Sanitary District be accepted. Dr. Current seconded the
motion and it was carried unanimously. (Resolution filed in Minute Book)
Mr. Charles Council presented a proposed revision of delayed certificate
of birth and instructions and application for filing the certificate. Mr.
Lutz moved that the revision be adopted. Mrs. Latta seconded the motion
and it was carried unanimously. (Copy filed in Minute Book)
Dr. Applewhite gave a report on the mental health program, and Mr.
Haswell described the operation of a mental health clinic (the Raleigh
Clinic).
The first draft of the recodification of public health laws had been mailed
to the Board members before this meeting. Dr. Norton announced that
a meeting of the committee which worked this out would be held on
January 18. He requested that either the Board plan to get together
with this committee, or that the President appoint a committee to meet
with this group. If it is not convenient for the entire Board or a com-mittee
to meet on that date, the date of the meeting could be changed. Dr.
Bender suggested a committee be appointed.
At this time Dr. Lawrence requested the Board to go into executive
session.
Dr. Dixon appointed Dr. Lawrence to serve with him as a committee
to meet with the committee on January 18.
North Carolina Board of Health 25
Dr. Current suggested that a copy of Dr. Haywood's recommendations
be sent to the Board members.
Dr. Elliot presented two problems with regard to consultants in the
crippled children's program. After some discussion, Dr. Dixon suggested
that Elliot bring a report to the next meeting of what has been done, with
his recommendations of what should be done.
The next meeting was set for 10:00 a.m., Thursday, February 23, and
other items on the agenda were postponed until that date.
February 23, 1956. The North Carolina State Board of Health met in
a called session, Thursday, February 23, 1956. The members assembled
in the office of Governor Luther H. Hodges, in the Capitol, where, at 9:30
a.m., Associate Justice Jeff D. Johnson, Jr., of the North Carolina Supreme
Court, administered the Oath of Office to Dr. Lenox D. Baker, Durham,
N. C, to fill the unexpired term of Dr. Hubert B. Haywood, who wrote
a letter of resignation to the Governor dated January 16, 1956.
Following the exercises in the Governor's Office, the Board went into
session in the Board Room of the Cooper Memorial Health Building. The
meeting was called to order by the President, Dr. G. Grady Dixon.
Minutes of the Board meeting held on January 12, 1956, were approved
as circulated.
Dr. Crump nominated Dr. Lawrence to fill Dr. Haywood's unexpired
term as Vice-President. Mr. Lutz seconded the motion, after which Dr.
Bender moved that the nominations be closed, seconded by Dr. Baker. The
vote was unanimous.
Dr. Lawrence moved that Dr. Bender be elected as the third member of
the Executive Committee to succeed Dr. Haywood in that capacity. Dr.
Crump seconded the motion which carried unanimously.
Dr. Lawrence moved a vote of thanks and welcome to the newest mem-ber,
Dr. Baker. This was seconded by Dr. Crump and carried unanimously.
Dr. Dixon read a message from Dr. Haywood, also a telegram from
Dr. Henderson notifying the Board that they could not be at the meeting.
Dr. Hugh A. Thompson of Raleigh and Dr. Oscar L. Miller of Charlotte,
invited guests, were recognized and asked to enter into the discussion, to
make any remarks and give any advice on the Crippled Children's Pro-gram,
which was subsequently taken up for review.
Mr. Jarrett presented the revised restaurant score sheet, copies of which
had been mailed to each member of the Board. Dr. Crump moved that the
Board approve the revised score sheet, and Dr. Current seconded the
motion. Dr. Baker abstained because he was not familiar with the sub-ject.
(Copy filed in Minute Book)
Mr. Jarrett explained a proposed order by the State Board of Health
making it mandatory for the Town of Louisburg to install an adequate
sewage disposal plant. Dr. Lawrence moved that the order be approved.
Mrs. Latta seconded it and the motion was unanimously carried. (Copy
filed in Minute Book)
Mr. Jarrett presented a petition from the Dare Beaches Sanitary
District to extend its boundaries. Dr. Crump moved that the annexation
26 Thirty-Sixth Biennial Report
be approved which was seconded by Mr. Lutz and unanimously carried.
(Copy filed in Minute Book)
Mr. Jarrett gave an explanatory report on a lawsuit that has been
entered in Wake County Superior Court against the State and the State
Board of Health by Mr. Wallace, a part-owner of the Howard Johnson
Restaurant of Rockingham, alleging that the system of grading res-taurants
and requiring the posting of grades A, B, or C, is unconstitutional.
Dr. Donald B. Koonce of Wilmington, President-Elect of the State Medical
Society, who was present, was welcomed and invited to enter into any
discussions he cared to.
Dr. Hamilton made a progress report on Postmortem Medicolegal Ex-aminations.
There are two committees functioning, a committee of the
State Medical Society and a Postmortem Medicolegal Examinations Com-mittee
set up by the 1955 Legislature. Dr. Hamilton said he felt that
the local health officer should not be considered for the job of Postmortem
Medicolegal Examiner.
Dr. Koonce was asked whether he thought the Examiner should be
the health officer. He said he was not familiar with the law that was
passed. It was his understanding of the original Bill that there would
be district pathologists, and, in each county, there would be a medical
examiner. He thought that the medical examiner certainly should not be
the health officer but, from a practical point of view, it is extremely
difficult to get a private practitioner to take that job, he said. In some
poorer counties it would be cheaper to use the health officer, he added.
Dr. Baker thought this law should have some kind of provision where
the county health officer could serve in that capacity, if the county com-missioners
could not get someone else, and that a loophole should be left
for that purpose.
Dr. Norton expressed the thought that the Laboratory Division might
be the logical place to center any special responsibility from the stand-point
of administration of work with the Postmortem Medicolegal Ex-aminations
Committee and made that recommendation. It was agreed
without formal vote that this should be done.
Dr. Foard made a progress report on the polio vaccine program, as
summarized up to the present time in material distributed to the members.
Further discussion of the Crippled Children's Program, continued from
the last meeting, was brought up and Dr. Elliot explained how physicians
get on the roster as participating specialists in the Crippled Children's
Program. He was asked at the last meeting to bring before the group
policies, plans, etc., and in the interest of giving everybody an opportunity
to study all this material at home before the meeting, he prepared and
mailed all of the important procedures, rules and regulations to each mem-ber
of the Board.
Dr. Lawrence expressed the hope that the Board could see fit to assure
that the number of participating specialists would be greatly increased.
He did not think that it should restrict the handling of these children to
the approximately 100 specialists to the exclusion of anyone else equally
well qualified.
North Carolina Board of Health 27
Dr. Baker remarked that he thought Dr. Elliot and Dr. Lawrence were
both right. Dr. Coppridge and his two associates are working in a hospital
that meets all qualifications of the Board, he said. He thought that the
vote of the Credentials Committee could be rescinded to take in these
men at both Watts and Lincoln Hospitals, in order to take care of the
children. Dr. Warner Wells (general surgeon) is not qualified for the
job for which he was applying, (that of plastic surgery) in his opinion.
Dr. Miller, who served on the Board in Washington twelve years, in
the beginning of Social Security, made the point that, above all things,
the children should be cared for. He hoped these minor problems could
be ironed out within the confines of the organization which has operated
Crippled Children's work for so long.
Dr. Thompson agreed with Dr. Miller, and added that, in handling a
program of this nature, it is necessary for the patients to be properly
taken care of by people who are fully qualified specialists, but if all are
placed on the roster who request it, it cannot be easily handled, from
an administrative standpoint.
Dr. Dixon made the point that the more people there are in this work,
the more there are who are supporting Public Health work. Dr. Lawrence
asked why so much of the orthopedic work has been sent to one hospital.
Dr. Elliot explained that the patient is treated by the orthopedist who
diagnoses his condition in the clinic. Nine out of ten attend one of the
Crippled Children's clinics throughout the State and they are hospitalized
where the orthopedist woi'ks. Orthopedists are assigned to clinics with
the recommendation of the local medical Society's Credentials Committee
and final approval by the State Board of Health. The hospital where the
patient is treated is usually determined by what orthopedist sees him in
the field.
Dr. Dixon thought the Board should know the action of the Specialty
definite program for adoption, setting forth, how it shall be done and
what shall be done; not too long, but something that can be understood
and to the best advantage of the money that goes into it, the best advantage
of the children, and the best advantage of those who are providing
the service.
Dr. Lawrence suggested that the President of the Board, together with
the Executive Committee and any other members of the Board that he
saw fit, have a meeting with the Executive Officer, Dr. Norton, and Dr.
Elliot, at which time they would attempt to work out a written policy.
Dr. Dixon thought the Board should know the action of the Specialty
Screening Subcommittees and Advisory Committee, and if the Board
should have responsibility for the action of the Advisory Committee, it
should be rseponsible for determining members of the Committee.
Dr. Norton asked if the Board wanted to pass on the members of the
Advisory Committee; if it wanted to pass on the roster of participating
specialists as they are screened through Specialty Subcommittees and then
approved or not by the Advisory Committee.
28 Thirty-Sixth Biennial Report
Dr. Lawrence said the specialists who are on this roster should have
Screening- Subcommittees and Advisory Committee approval, and also
that men declined admission to the roster should be permitted to appeal
to the Board. No objection was expressed to this statement.
Dr. Kendall explained how the question of participating consultants
came up.
It was agreed that if any action should be taken before the next meeting
of the Board, there should be consultation with the Executive Committee.
As to representation on the North Carolina Health Council, to replace
Dr. Haywood, as associate member, Dr. Dixon asked Dr. Lawrence to
serve. Dr. Lawrence asked that he be excused and suggested Dr. Crump.
Dr. Crump moved that Dr. Dixon be designated. The motion was seconded
by Mr. Lutz. Dr. Dixon voted "no," but the motion was carried. Dr. Dixon
returned to the Chair, having left it while the motion relative to him was
pending.
The recommendations and motions Dr. Haywood presented to the Board
in a written statement at the last meeting were taken up individually,
as follows:
"I move that the Executive Committee of the State Board of Health
meet once a month." Dr. Crump seconded the motion. Dr. Baker asked
for an amendment to the motion, "meet four times a year, spaced between
and in addition to regular Board meetings." This amendment was accepted
by Dr. Crump and Dr. Lawrence seconded the amendment. If there is
a called meeting of the Board, it will serve as a regular meeting of the
Executive Committee. Unanimous.
"I move that the members of the Executive Committee serve staggered
terms of three years each and that an interim of at least two years shall
intervene before they are re-elected to the Executive Committee." No
second.
"I move that the Chairman of the Board of the State Board of Health
shall serve not over six years consecutively and that a three year period
shall intervene before he may be re-elected Chairman." No second.
"I move that this shall also apply to the Vice-Chairman." No second.
"I move that a Finance Committee be elected by the Board from their
members by the Boaid, to serve as the other Boards will do for three year
periods, on a staggered basis." No second.
"I move that a Grievance Committee be elected by the Board from its
members to hear any complaints from employees about promotions and
salary raises." No second.
"I move that committees be appointed to confer with and familiarize
themselves with the various departments (divisions) of the State Board
of Health." Dr. Current suggested one Board meeting be devoted to hear-ing
division reports. Dr. Bender moved that there be a liaison officer
from the Board to represent each division of the State Board of Health,
seconded by Dr. Current. Each member present was given opportunity
to express a preference and Dr. Dixon filled in the remainder as follows:
North Carolina Board of Health 29
Central Administration Mrs. J. E. Latta
1. Personal Health Division Dr. Lenox D. Baker
2. Epidemiology Division Dr. John P. Henderson, Jr.
3. Sanitary Engineering Division Mr. H. C. Lutz
4. Oral Hygiene Division Dr. A. C. Current
5. Local Health Division Dr. John R. Bender
6. Laboratory Division Dr. G. Curtis Crump,
leaving the Board President and Vice-President without specific liaison
assignments. It was discussed that these liaison assignments to divisions
should be rotated at about yearly intervals in order that all Board mem-bers
could become familiar with the entire program.
"I move that at least one meeting of our Scheduled four meetings
relationship to the State Board of Health's programs." No second.
"I move that a committee be appointed on Social Legislation and its
be devoted to a large extent in getting reports from these committees."
No second, but with comment that liaison responsibilities assigned above
should assure adequate reporting to the full Board.
Dr. Bender moved that the two motions that were revised and amended
be accepted by the Board. Dr. Lawrence seconded the motion and it was
unanimously carried.
Dr. Dixon expressed the hope that the Board would pass a similar reso-lution
for Dr. Haywood as for Dr. Johnson, ten or twelve years ago, printed
on a parchment scroll. Dr. Lawrence moved that a suitable resolution of
respect and appreciation and gratitude to Dr. Haywood for the services
rendered this Board be prepared and signed by each member of the Board,
and that the Board as a whole, or committee designated, present it to him,
preferably, if he is able to be there and his health will permit, at the next
Conjoint Session of this Board and the State Medical Society. Seconded
by Dr. Current, and unanimously carried.
Dr. Dixon asked every member of the Board to go over the second
draft of the proposed recodification, make notations of the changes that
have been made that they do not agree with, or changes that they think
should be made, and after they have gone through this, then reduce that
to a letter or statement, chapter by chapter, and if there is any member
of the Board that does not want to make any suggested changes, so write
the State Health Officer. When all members of the Board have been heard
from,—that a special meeting be called to go over that for its last
approval or disapproval. Dr. Lawrence made such a motion. Seconded by
Dr. Bender and unanimously carried.
April 19, 1956. On Thursday, April 19, 1956, the Executive Committee of
the State Board of Health composed of Dr. G. Grady Dixon, Dr. Hen J.
Lawrence and Dr. John R. Bender, met. Dr. Dixon called the meeting to
order.
Mr. John Andrews presented a proposed revision in the hulk milk dis-penser
requirements of the restaurant regulations. Item 17 of the res-taurant
regulations (page 27) allows the use of bulk milk dispensers. The
milk regulations adopted by the Richmond County Board of Health do not
allow the use of bulk milk dispensers in Rishmond County. Possible con-
30 Thirty-Sixth Biennial Report
flicting interpretations can be eliminated by changing the State Board of
Health restaurant regulations to allow bulk milk dispensers "where per-mitted
under the regulations of the local Board of Health." If the State
Board of Health should decide to make this change, the clause quoted could
be inserted on line 8 of Item 17 (page 27), between the words "that" and
"sanitary." With this change, the third sentence of Item 17 would read as
follows (addition underlined)
:
"Milk and milk products shall be served in the individual, original con-tainers
in which they were received from the distributor, so that the name
and grade of the contents and the name of the milk distributor may be
oberved readily by the consumers; provided that, where permitted under
the regulations of the local Board of Health, sanitary bulk milk dis-pensers
which have been approved by the State Board of Health may be
used if so located and so labeled that the name and grade of the contents
and the name of the milk distributor may be observed readily by the
consumers; provided further, that in the case of restaurants and hotels
having several banquet halls and dining rooms served from a central
kitchen, if careful investigation proves it impractical to locate the milk
dispenser in a dining room because of established food checking and serv-ing
routines, the milk dispenser may be installed in the food serving area
of the kitchen in a location specifically approved by the health officer
and the label information required by this item shall be shown prominently
on the menu cards instead of on the milk dispenser cabinet."
Dr. Lawrence moved that the revision be adopted. Dr. Bender seconded.
At Dr. Norton's request, Mr. Andrews reported on how the Howard
Johnson litigation was settled. He also commented that relations with
Howard Johnson Restaurants is, in general, good.
Dr. Foard gave a brief report on the distribution of polio vaccine with a
total allocation to date for North Carolina of about 940,000 ccs. from
Federal funds.
Dr. Norton read a letter from Dr. LeRoy Hand, Jr., Gatesville, which
had been published in the News and Observer. He reported that he had
written Wyeth and Lilly for comments on Dr. Hand's letter.
Dr. Norton asked Dr. Foard to give a brief report on Cabarrus County.
A little more than 80 per cent of the children under 20 in Cabarrus County
have been given two doses of polio vaccine, and the County Medical Society
has requested enough vaccine to make a hundred per cent. The Public
Health Service plans to use Cabarrus County in a study on the effects
of administration of polio vaccine. Practically all of the vaccinations were
done by the health department—the Medical Society advocated that people
go to the health department.
Dr. Norton reported that he and Dr. Rousseau both feel that the useful-ness
and necessity for the Polio Advisory Committee has just about ended,
from the standpoint of having anything other than the State Board of
Health pick up and carry on from there. Dr. Rousseau is in complete agree-ment
and actually recommends that we go ahead and make a report to the
Governor on the progress of the vaccination against polio. He suggested
that Dr. Norton gather up the information, summarize it and take it over
to the Governor and suggest to him that he terminate the Advisory
Committee and designate the State Board of Health to follow-up with
North Carolina Board of Health 31
that. Dr. Bender commented that the State Board of Health might be
glad to have this committee if a lot of polio breaks out this summer and
other Executive Committee members seemed inclined to agree with him.
Dr. Dixon introduced Dr. Ellen Winston and Dr. John Ferrell, who
had joined the group to present the proposal of the State Health Council
for first aid service for State employees. Dr. Winston gave the background
and described the proposed plan worked out by a committee of the State
Health Council for a preventive health service for State employees for
the purpose of reducing absenteeism, reducing labor turnover, improving
employees' morale and greater working effectiveness. It was suggested
that one station, under the supervision of the State Board of Health, be
staffed with one nurse, on a pilot basis, for State employees in Raleigh
only. Dr. Ferrell described the State program in Connecticut, the only
state which has such a program, and also commented briefly on the
emergency service in Washington which was developed and supervised
by the U. S. Public Health Service for Federal employees.
After much discussion, Dr. Lawrence suggested that the matter be
taken under advisement and referred to the full Board.
Dr. Foard reported to the Committee that he and Dr. Norton just
found out about an industry tax collected for industrial health purposes
of about $150,000 per annum which has been going into the State General
Fund. He also mentioned the fact that because of the low salaries paid
by the State, the Industrial Hygiene Section has been without an engineer
since the death of Steve Marsh last July. Dr. Dixon suggested that we
find out several things; first, when that tax was levied, how long it has
been collected, and why it was collected and how much is collected annually,
if it was levied for the purposes of industrial health, who has that money
been assigned to?
Dr. Foard called attention to the growing hazard of the use of atomic
energy in industrial plants, and the need for more personnel in the Indus-trial
Hygiene Section. Dr. Foard recommended that the State Board of
Health take under consideration a resolution that would recommend ade-quate
support from an industrial hygiene appropriation standpoint. Dr.
Dixon requested a report on answers to the above questions to the next
meeting of the Board on May 2nd.
Adjourned for lunch.
The next item taken up by the Committee was discussion of the Haywood
scroll. It was left up to Dr. Hamilton to have the scroll made up and to
have it at the Conjoint Session at Pinehurst for presentation. Dr. Dixon
took personal responsibility for the members of the Board taking care of
the cost, which will be about $100.00.
Mr. Roddey Ligon, of the Institute of Government, Chapel Hill, made a
progress report on bringing health regulations up-to-date. He said that
suggested changes in Chapter 130 will be in Dr. Norton's hands in a few
days. Other areas outside of Chapter 130 will be taken up with the State
Department of Agriculture and any other departments involved before
any changes can be made. Dr. Dixon told him that a committee of the
32 Thirty-Sixth Biennial Report
Board will have a meeting on April 29 and may have some suggested
changes to turn in to him.
Dr. Applewhite presented proposed changes in board policies on allo-cation
of funds to local health departments, with reference to oral hygiene
programs in the local departments. Miss Deynolds presented the budget
programs in the local departments. Miss Reynolds presented the budget
Dr. Applewhite and Dr. Branch to work out and bring up at the next
meeting.
Dr. Elliot asked for approval of the Board for the way the Crippled
Children's program has been operated up to now, with the understanding
also that the Board will in the future, determine any new policies, changes
in policy, selections of clinic directors, additions to the participating roster
and to the Advisory Committee and Credentials Committees. He also re-quested
approval of the two recommended for addition to the roster. (Dr.
Louis Carroll Roberts and Dr. Jack Hughes of Durham).
Dr. Norton was requested to prepart a resolution to the whole Board
that this committee be set up as the formal advisory committee, that they
be commissioned by the Board of Health and that they be commissioned
for two and four years, alternately and alphabetically on the list.
Formal action on the Credentials Committees was postponed. With ref-erence
to the two urologists to be admitted to the roster, Dr. Roberts and
Dr. Hughes of Durham, Dr. Lawrence moved that approval be rocemmended
and Dr. Bender seconded the motion.
May 2, 1956. The annual meeting of the North Carolina State Board of
Health was held at the Carolina Hotel, Pinehurst, North Carolina, May 2,
1956, with President Dixon presiding.
The meeting was called to order by the President. Minutes of the Board
meeting held on February 23, 1956 were approved with an amendment
suggested by Dr. Lenox Baker relative to "Liaison assignments" to
divisions. This correction has been made.
Dr. Baker moved that the minutes of the Executive Committee meeting
held on April 19, 1956, be held in abeyance until a future meeting. Motion
seconded by Dr. Current, and carried.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was
present and presented a proposed resolution regarding bulk milk dis-pensers.
Mr. Jarrett discussed the subject in detail and said there was a
possibility of a conflict between the regulations of the State Board of
Health and the milk regulations of local Boards of Health. The possibility
of such a conflict could be prevented by changing the State Board of Health
regulations governing the sanitation of restaurants, private hospitals,
sanatoriums, sanitariums, educational institutions, and summer camps so
as to permit the use of bulk milk dispensers "where permitted under the
regulations of the local Board of Health." Upon motion of Dr. Current,
seconded by Dr. Baker, the following resolution was unanimously adopted:
—
"Be it resolved that the rules and regulations governing the sanitation of
restaurants, as adopted by the State Board of Health at Winston-Salem.
North Carolina, on September 23, 1955 be amended as follows:
"In Section 6, Item 17, third sentence, after the words 'provided that,' insert
North Carolina Board of Health 33
the words, 'where permitted under the regulations of the local Board of
Health';
"Be it further resolved that the rules and regulations governing the
sanitation of private hospitals, sanatoriums, anitariums and educational
institutions, as adopted by the State Board of Health at Raleigh, North
Carolina on August 7, 1946 and revised at Raleigh, North Carolina on
July 1, 1954, be amended as follows:
"In Section 6, Item 16 (as revised), seventh sentence, after the words
'provided that,' insert the words, 'where permitted under the regulations
of the local Board of Health';
"Be it further resolved that the rules and regulations governing the sani-tation
of summer camps, as adopted by the State Board of Health at
Virginia Beach, Virginia on May 14, 1947, and revised at Raleigh, North
Carolina on July 1, 1954, be amended as follows:
"In Section 7, Item 10 (as revised), seventh sentence, after the words
'provided that,' insert the words, 'where permitted under the regulations
of the local Board of Health.'
In Dr. Fred T. Foard's absence, who was in Washington, D. C. attending
a conference on poliomyelitis vaccine called by Surgeon General Scheele,
representing the North Carolina State Boai'd of Health, Secretary Norton
made a progress report on polio vaccine. He stated that the Board had
just received a wire announcing the largest shipment of vaccine yet
(96,000 ccs.) and that it was understood that there was an increasing
amount of vaccine in the assembly lines which takes about four months to
complete and that it is expected that soon the vaccine will be coming in
in increased amounts. Dr. Norton also discussed a report on poliomyelitis
vaccine which had been circulated to all Board members regarding the
vaccine distribution to be discussed at a meeting to be held Sunday, May
6, with the North Carolina State Advisory Committee on Poliomyelitis
Vaccine and as Chairman of that Committee invited Board members to
attend. Dr. Dixon stated he would try to attend.
At the request of Dr. Norton, Mr. William H. Richardson, Publicity
Officer, reported the results of an investigation concerning monies paid
into the Industrial Commission by self-insurers. There had been some mis-understanding
as to whether these monies, which are deposited in the Gen-eral
Fund, could be retrieved and used by the State Board of Health or the
Industrial Commission. It was learned that this fund, amounting to an
average of around $130,000 a year, is collected for purposes other than
services provided by the State Board of Health.
Dr. C. C. Applewhite, Director of the Division of Local Health, presented
the proposed policies of the North Carolina State Board of Health for
allocation of State aid funds to local health departments. The policies were
explained very carefully by Dr. Applewhite and discussed. Upon motion
of Dr. Lawrence, seconded by Dr. Current, the new "Policies of the North
Carolina State Board of Health for Allocation of State Aid Funds to Local
Health Departments" were unanimously passed. (Copy of policies filed
in Minute Book
)
Dr. Applewhite also presented proposed policies of State and Federal
Funds for the Mental Health program. After due explanation, and dis-cussion,
Dr. Lawrence moved, and seconded by Dr. Current, that the Board
postpone definite action on Mental Health policies until a subsequent date
34 Thirty-Sixth Biennial Report
but authorized the State Board of Health to proceed as usual with the
allocation in accordance with previously used methods.
Mr. Jarrett presented a request for the creation of a sanitary district at
Havelock, Craven County, North Carolina. He stated that all documents
and transactions had been examined by his office and were in his opinion, in
order, and in compliance with the law, and he recommended that the State
Board of Health act favorably on the creation of this Sanitary District.
The matter was discussed and upon motion of Dr. Current, seconded by
Dr. Henderson, the "Resolution of the North Carolina State Board of
Health creating the Havelock Sanitary District in Craven County" was
unanimously passed.
Mr. Jarrett also presented a x-equest for the extension of the boundaries
of the Walkertown Sanitary District in Forsyth County. He stated that
the documents, as well as the various transactions relative to this matter
had been examined by his office and were in order, and because of the need
for sanitary improvements in the proposed area to be annexed, he recom-mended
favorable action by the Board. On motion of Dr. Baker, seconded
by Dr. Lawrence, the "Resolution extending the boundaries of the Walker-town
Sanitary District in Forsyth County, North Carolina," was passed
unanimously. (Copy of resolution filed in Minute Book)
Then, Mr. Jarrett presented a request from the Town of Mebane, North
Carolina, to allow controlled fishing in the municipal water supply lake.
He stated that due to strict regulations controlling fishing activities that
he felt that no unfavorable effects would be experienced in the quality of the
water and that it would be safe from a public health standpoint. On motion
of Dr. Baker, seconded by Dr. Current, the "Resolution of the North Caro-lina
State Board of Health authorizing the Town of Mebane, North
Carolina to permit fishing in Lake Michael Municipal Water Supply Lake,"
was passed unanimously.
Dr. Dixon announced the meeting of the North Carolina Public Health
Association to be held in Charlotte, North Carolina, May 31-June 1, 1956.
The question as to whether or not a Board meeting should be held during
the meeting was discussed, etc. Dr. Bender moved, and it was seconded by
Dr. Henderson, that if there is enough Board business, that the Board
hold a regular meeting at 2:00 p.m. on Friday, June 1 at the same time and
place of the NCPHA meeting at Hotel Charlotte. Motion carried.
Secretary Norton discussed the letter he had sent to Mr. George B.
Cherry, Superintendent of Buildings and Grounds, requesting consideration
of air-conditioning of the Health Building and that if the entire building
could not be air-conditioned, special consideration was requested for the
first three floors of the building. The Board approved of the Secretary's
request for air-conditioning, and asked that Mr. Cherry be informed that
the Board officially and respectfully requests that the entire building be
air-conditioned as soon as possible.
Dr. B. M. Drake, Co-Director of the School Health Coordinating Unit,
which is a coordinated service jointly of the Education Department and
the State Board of Health, gave a brief summary of the School Health
Program. He discussed the functioning of the service for the last two
North Carolina Board of Health 35
years and brought the Board up-to-date as to the restrictions placed on
the use of school health funds by the last Legislature. Dr. Drake also cir-culated
to the members other pertinent data: policy governing the expendi-ture
of State Board of Education Child Health funds, a schedule of dental
fees and a copy of a memorandum to Dr. Norton concerning the formation
of a joint school health committee. After a discussion, it was suggested
that Dr. Drake and Mr. Charles E. Spencer, who is also Co-Director, draw
up resolutions relative to the joint Committee that they would be willing
to have presented to both departments (State and Education Boards) at
the next meeting of the Board.
At this point, Dr. Crump moved and Dr. Baker seconded that the Board
declare itself in Executive Session. Motion carried.
Mr. James T. Barnes, Chairman of a Committee of the N. C. Health
Council, was invited to the meeting. He explained the establishment of a
first aid station for State employees—the Health Council having adopted
this one project for the year; that the purpose was not treatment of ail-ments
except basic first aid. The three functions of the station would be:
screening, providing aid for minor ailments in order that an employee
might stay on the job, and prevention through education. (A description
of Preventive Health Service for State Employees as prepared by Mr.
Barnes had previously been mailed to each member). Dr. Baker moved
that the State Board of Health, as of now, go on record as disapproving the
health service as outlined by the Committee for State employees. Motion
seconded by Dr. Bender, and passed unanimously.
There was only a brief discussion of the progress on recodification of
health laws and regulations. It was moved by Dr. Crump, and seconded
by Dr. Lawrence, that the President of the Board of Health appoint a
committee from the Board to make an official draft of the recodification of
the public health laws of North Carolina. Motion carried. Dr. Crump was
appointed Chairman of this group with power to select other members
from the Board, and to get together at any time to study in particular
the sections on oral hygiene, pharmacy, medical laws and regulations,
sanitation, dairying, etc.
On motion duly made and seconded, the meeting adjourned for the Con-joint
Session of the Medical Society of the State of North Carolina and the
State Board of Health as required by law on the second day of the annual
meeting of the Medical Society. President Dixon presided at this meeting.
After the recognition of the now member, Dr. Lenox D. Baker, the Secre-tary,
presented his annual report. President Dixon then called Dr. Ernest
A. Branch to the platform and praised his leadership, internationally rec-ognized,
in Oral Hygiene work which has reflected credit on the Board,
the State and on Dr. Branch and the entire dental profession.
President Dixon then called Dr. Hubert Haywood to the platform and
presented to him a scroll prepared by fellow Board members in recognition
of his distinguished service in his work with the Board as a member, and
on the Executive Committee and as Vice-President. A copy of the scroll
follows:
36 Thirty-Sixth Biennial Report
"TRIBUTE OF ESTEEM, LOVE AND AFFECTION TO
DR. HUBERT BENBURY HAYWOOD, B.Ph., M.D., L.L.D.
"The North Carolina State Board of Health wishes to recognize with
sincere appreciation and respect the faithful service and splendid leader-ship
furnished by HUBERT BENBURY HAYWOOD. Born in Raleigh in
1884, he has engaged in the general practice of medicine in Raleigh all of
his professional life. In this individual and family servce he has attained
happiness and eminence and developed the background of understanding for
guidance in preventive health services for his community and State. First
appointed to The Board by his trusted friend, Governor J. C. B. Ehringhaus
in 1934, each of the succeeding Governors, Hoey, Broughton, Cherry, Scott
and Umstead, respectively, reappointed him to succeed himself. Much of
the progress of public health in North Carolina during the last 20 years
may be attributed to his vision, his matchless and sterling character, and
the persuasive power of his diplomacy on many occasions. He has been
faithful in his efforts on behalf of the State Board of Health and matters
assigned to him have received his careful and painstaking consideration.
"DR. HAYWOOD is a Fellow of the American College of Physicians, a
member of the American Medical Association, a member and past president
of the Medical Society of the State of North Carolina and the Raleigh
Academy of Medicine, and a lineal descendant of one of the original
founders of The Academy. He was one of the senior members of the State
Board of Health, and at the time of his resignation was Vice-President
and a member of its Executive Committee. He wears his laurels with such
dignity, refinement and scholarly understanding, together with his ever
present genial smile and love and affection for his fellowman that these
qualities clearly mark him as an understanding and loyal friend, an emi-nent
physician and scientist.
"We salute you, DR. HAYWOOD, and bespeak for you that degree of
satisfaction and sweet calm that can come only to one who has lived a
rich and useful life in devoted and dedicated, and always intelligently
constructive medical and health service to this and all future generations
in North Carolina.
Signed: G. Grady Dixon, M.D., President
Ben J. Lawrence, M.D., Vice-President
John R. Bender, M.D.
A. C. Current, D.D.S.
G. Curtis Crump, M.D.
H. C. Lutz, Ph.G.
Mrs. J. E. Latta
John P. Henderson, Jr., M.D.
Lenox D. Baker, M.D.
J. W. R. Norton, M.D., State Health Officer
John H. Hamilton, M.D., Asst. State Health Officer.
June 1, 1956. A meeting of the North Carolina State Board of Health
was held at the Hotel Charlotte, Charlotte, North Carolina, Friday, June
1, 1956, 2:00-5:36 p.m., at the time and place of meeting of the 45th Annual
Session of the North Carolina Public Health Association, with President
Dixon presiding.
Also present for the meeting were Eugene A. Gillis, M.D., Region III
Medical Director, USPHS, M. B. Bethel, M.D., Mecklenburg County Health
Officer and E. H. Ellinwood, M.D., Guilford County Health Officer, both
Past Presidents of the NCPHA, and Dr. Bethel is President of the Mecklen-burg
County Medical Society; and E. G. McGavran, M.D., Dean of the UNC
School of Public Health and President of the NCPHA.
North Carolina Board of Health 37
Dr. Gillis, Regional Medical Director of Charlottesville, Virginia, at
the invitation of President Dixon, gave an informative discussion regarding
the poliomyelitis vaccine allotted to North Carolina. He reported on the
amount of vaccine which has stockpiled from manufacturers and remained
unsold to druggists and physicians in North Carolina. He pointed out that
the present 30 per cent to public agency and 70 per cent to private physi-cians
as allocated by the State Poliomyelitis Vaccine Advisory Committee
also provided that counties may become eligible to receive additional
amounts on official requests from both the local health officer and the
local medical society. He suggested that it might be well to devise some
other plan since some of this accumulating surplus vaccine is not available
to any one. With a present accumulation of over 100,000 ccs. surplus and
a new total allotment of 245,000 ccs. today he reported that among the
states in Region III North Carolina has the greatest accumulation of vac-cine
allocated for use by private physicians and undistributed by the manu-facturers,
and that other states are clamoring for it. Dr. Baker objected
to the reference to the surplus in the 70 per cent allocation and also in
regard to the occasional erroneous impressions left by newspaper publicity
that seemed unduly critical of private physicians. Dr. Baker moved that
the State Board of Health employee personnel be instructed by this Board
not to release any more publicity in regard to the vaccine program that
even mentions the 30% -70% distribution. Dr. Lawrence said he would like
to second this motion with this amendment, which was accepted by Dr.
Baker, "that no release be given out for publicity until said release has
been carefully scrutinized by Dr. Norton, or someone designated by him
to make certain that there is nothing in such release to reflect undue criti-cism
upon the private practitioners of this State." Dr. Lawrence asked
Dr. Norton if this was agreeable with him. Dr. Norton commented that he
considered such a motion unnecessary and since Board minutes are public
property it might be subject to interpretations unfavorable to the Board
from a public relations standpoint. "Dr. Baker explained that the reason
for his motion was the publicity that had come out of Raleigh, regardless
of its source, had insinuated that 70% of the vaccine was being held tied
up by private physicians for their use and was not available to the public
health services and that it had not been made clear that, even though the
vaccine was subject to being so issued, that any and all vaccine was subject
to release and was available for purchase by public health agencies by
the simple process of the local health departments with the approval of
the local medical societies, applying for additional funds for purchasing
such vaccine which is on the market and which is available. Previous
publicity has not explained this aspect of the situation satisfactorily and
there has been confusion both on the part of the public and many of the
physicians of the State who have been justifiably concerned regarding the
poor light in which the medical profession has been thrown by the failure
of the public not getting a truer understanding of the situation." Motion
unanimously carried.
The minutes of the Board meeting held on May 2, 1956, were approved.
Action on the minutes of the Executive Committee Meeting held on
38 Thirty-Sixth Biennial Report
April 19, 1956, was deferred until the next meeting of the Executive Com-mittee.
Dr. John H. Hamilton, Director of the Laboratory of Hygiene Division,
was present and discussed the advisability of expanding the cytology serv-ice.
He reviewed what the Laboratory has been doing in cytology as a back-ground
and the policy that has been followed for the last twelve years.
He added that any expansion for the next three years would best be re-flected
in the early fall budget presentation. Dr. Lawrence moved that
whereas Dr. Hamilton has seen fit to present to the Board some remarks
with reference to this service which has been rendered in the field of cancer
cytology, namely, Papanicolaou, and whereas it appears from his brief
presentation that it is a service which the Laboratory of Hygiene could
advisedly render to the people of this State, and whereas the State Board
of Health desires the full cooperation and support of the Medical Society
of the State of North Carolina in its effort to render service to this State,
the Board requests that Drs. Hamilton and Norton should, at such time as
feasible, secure the opinion of the Medical Society of the State of North
Carolina, and report back to the Board. Motion seconded by Mr. Lutz.
Dr. Bender expressed a belief that the Board should make its own decision
now. Motion carried.
Dr. A. H. Elliot, Director of the Personal Health Division, presented a
request from Dr. Ann DeHuff Peters of the North Carolina Memorial
Hospital, Chapel Hill, to use only normal salt solution in the eyes of new-born
babies instead of silver nitrate. Dr. Elliot stated that he had written
Dr. Peters that the question of permitting the use of antibiotics in the
eyes of the newborn instead of silver nitrate had been presented to the
Board on several occasions but at no time had serious consideration been
given to departing from the use of silver nitrate (except in a proposed
study of the effectiveness of penicillin at the medical schools). The matter
was discussed at length, but no action was taken and deferred until the
next Board meeting, in order for the Board to consider the feasibility of
carrying out such a suggested procedure as outlined by Dr. Peters. Dr.
Norton was requested to secure information on what materials other than
silver nitrate had been used in this State and elsewhere and with what
results. Such information should be presented at the next meeting of the
Board. Dr. Baker suggested that it might be best for the Board to reach
a decision as to what they thought would be best and let it be written into
law.
Dr. Elliot also discussed the Crippled Children's program very briefly,
and stated that the Credentials Committee on Urology and the Advisory
Committee to the Crippled Children's program has approved Dr. Jack
Hughes and Dr. Louis Carroll Roberts of Durham for admission to the
Crippled Children's roster of Urology specialists and asked that the approval
of the State Board of Health be given. Dr. Baker moved that Doctors
Hughes and Roberts be approved by this Board for urology in the Crippled
Children's Section as recommended by the Credentials and Advisory Com-mittees.
Motion seconded by Dr. Current, and carried.
North Carolina Board of Health 39
Secretary Norton gave a brief report on the activities of the North
Carolina Cancer Institute in Lumberton. The trusteees of the North Carolina
Cancer Institute, the North Carolina Division of the American Cancer
Society and the Cancer Committee of the Medical Society of the State of
North Carolina recommended an institution for treatment and care of
indigent terminal cancer patients at or near a teaching center, and asked
that Dr. Norton bring the matter before this Board. The subject was dis-cussed
at length. Dr. Current moved, seconded by Dr. Baker, that the
Board of Health act favorably upon the following resolution.—"that an
institution for care and treatment of terminal cancer patients be estab-lished
at or near a teaching medical center." Motion carried unanimously.
Then Secretary Norton requested informal comment on whether or not
the Board would approve having funds for the institution, referred to
above, if established, coming through our budget office as was done with
funds for renovation of the Cancer Institute at Lumberton. It was the
consensus that the Board would prefer that our budget office not handle
this item.
Dr. Elliot suggested to the Board that Dr. W. Ralph Deaton, Jr., of
Greensboro, be approved for lung surgery by the Board; and further that
Dr. Deaton's approval for heart surgey be delayed until he has had more
experience in this field in accord with recommendations of the appropriate
Credentials Committee. Dr. Elliot submitted data on Dr. Deaton's prepara-tion,
training and experience. Dr. Baker moved, seconded by Mr. Lutz,
that Dr. W. Ralph Deaton, Jr., of Greensboro, North Carolina, be approved
as recommended by the Credentials Committee for lung surgery. Motion
carried. Approval for heart surgery was withheld until the applicant has
had more experience in this field.
In the absence of Dr. G. Curtis Crump, Chairman of the Committee to
study the revision and recodification of public health laws, Dr. Dixon made
a brief report. He also stated that Dr. Crump wished to be relieved of this
chairmanship as he was so far away from the center of the State and that
the Committee would get together and name a chairman later. In discuss-ing
revisions in the public health laws, the Board especially took cognizance
of the change in designating the title of Secretary and State Health Officer
to Commissioner of Health. At a meeting on Septemebr 23, 1955, a motion
was made by Dr. Crump, seconded by Dr. Current, suggesting the following
terminology: "that the term 'Commissioner of Health' or 'Health Commis-sioner'
be used instead of the present 'Secretary-Treasurer and State
Health Officer.' " Dr. Current moved that the terminology used in the
minutes of the September 23, 1955 Board meeting be rescinded and that
the Board continue to use the title of "Secretary-Treasurer and State
Health Officer" as at present. Dean McGavran asked if he might comment
on the basis for the general trend away from the use of "Officer" in many
states, but Dr. Lawrence insisted that the vote be taken and that then a
courteous hearing be accorded Dr. McGavran, and this was done. Motion
seconded by Mr. Lutz, and carried.
In a further discussion of the Crippled Children's program and Advisory
and Credentials Committees, the following motions were made: Dr. Baker
40 Thirty-Sixth Biennial Report
moved that the names of Dr. Julian Deryl Hart, Duke Hospital, Durham and
Dr. N. A. Womack, N. C. Memorial Hospital, Chapel Hill, be deleted from
the thoracic and cardiac Credentials Committee. Motion seconded by Dr.
Lawrence, and carried.
Dr. Baker moved that the name of Dr. James Austin Valone of Raleigh
be added to the list eligible for plastic surbery. (There was no report of
request to, or action by, the Credentials Committee). Motion seconded by
Dr. Lawrence, and carried.
Dr. Baker moved that Dr. J. Leonard Goldner, Durham Orthopedist and
hand surgeon, be added to the Advisory Committee. Motion seconded by Dr.
Bender, and carried.
Dr. Lawrence moved that the name of Dr. Frank R. Johnston, Genei'al
Surgeon, Bowman-Gray School of Medicine, Winston-Salem, be added to
the Advisory Committee list. Motion seconded by Dr. Bender, and carried.
Dr. Baker moved that Dr. J. S. Gaul, Orthopedist, be removed from the
Advisory Committee of the Crippled Children's Section and that his son,
Dr. John Stuart Gaul, Jr., be added instead. Motion seconded by Dr. Law-rence,
and carried.
Dr. Baker moved that the President-Elect of the North Carolina Academy
of General Practice be made an ex-officio member of the Advisory Com-mittee
of the Crippled Children's Section. Motion seconded by Dr. Lawrence,
and carried.
Dr. Baker moved that Dr. Wayne Jefferson Benton of Greensboro, be
made a member of the advisory Committee of the Crippled Children's
Section. Motion seconded by Dr. Lawrence, and carried.
On motion duly made and seconded, the meeting adjourned at 5:.°>0 p.7n.
North Carolina Board of Health 41
CHRONIC DISEASES-A JOINT
RESPONSIBILITY OF PRIVATE PRACTICE
AND PUBLIC HEALTH *
By J. W. R. Norton, M.D., M.P.H., F.A.C.P.* ::
Raleigh
In the long span of recorded time on this planet fifty years is as the
twinkling of an eye but medical progress during this period has exceeded
that of many prior centuries. For the twenty-eighth year after the estab-lishment
of the North Carolina State Board of Health, Dr. Cooper in his
chronological summary for 1905 had this to say for a year just before the
beginning of intensified joint efforts against communicable diseases:
"General Assembly established State Laboratory of Hygiene; imposed
water tax of $64 on all public water companies; voted $600 annually for
the support of laboratory. Small appropriation made it necessary for the
Department of Agriculture to continue to assist State Board of Health.
Annual appropriation, $2,000."
Even the barest outline or summary this year of public health services
provided by the state and the sixty-nine local health departments serving
all 100 counties would require many pages. Concurrently with the well-known
vast and rapid changes in the private practice of cm-ative medicine
has come similarly impressive progress in preventive medicine and public
health. Through the years a few physicians have voiced fears that they
would have no work if preventive measures were applied to all ills and
injuries practically preventable. We heard such comments from a few with
regard to vaccinations against smallpox, typhoid, diphtheria, whooping-cough
and tetanus, against the planned parenthood program, against the
school health program, against the venereal disease and tuberculosis con-trol
programs. We hear less of these short-sighted objections today but
there are a few who would limit public health sei'vices to the indigent and
against only the communicable diseases.
With improved educational methods and more widespread use of pre-ventive
measures, prompt diagnosis and greatly enhanced effectiveness of
treatment procedures the communicable diseases have come under rela-tively
effective control with the exception of tuberculosis. Recent examples
are the Salk vaccine against poliomyelitis and certain antibiotics against
rheumatic fever. The former Captain of the Men of Death, tuberculosis,
has dropped until now it is not even among the first ten killers except in
limited age groups.
In 1954 diseases of the heart and blood vessels, cancer, accidents, nephri-tis
and diabetes accounted for 22,62:; deaths out of a total of 32,072 in
North Carolina. Mental disorders accounted for half the persons hospitalized.
* Read before the Conjoint Session of the Medical Society of North Carolina and the Slate
Board of Health, l'inehurst. May 4. L956.
** Secretary-Treasurer of the State Hoard of Health and State Health Officer.
42 Thirty-Sixth Biennial Report
Arthritis caused an enormous amount of disability and hospitalization.
Improper nutrition caused decreased vitality and lowered efficiency in
many. All these, except accidents, are in the non-communicable field or area
of chronic disorders. Most medical leaders agree that much progress could
be made against them by health education, early diagnosis and prompt
medical treatment and supervision.
We are now at about the stage of medical knowledge regarding these
chronic non-communicable disorders in which our predecessors found them-selves
when joint efforts of private practice and public health began to be
coordinated against the communicable diseases. The opportunity is afforded
us to proceed humanely and cooperatively as was done so successfully
against the infectious diseases.
When the Medical Society of North Carolina stimulated the establish-ment
of the State Board of Health and local health departments, medical
leaders considered the situation with regard to communicable diseases to
be intolerable. Our successful joint efforts have prolonged the life span
and helped to create the present intolerable situation with regard to the
chronic non-communicable disorders and our mechanical progress has con-tributed,
at least in part, to our deplorable accident situation. Even such
problems as rehabilitation and stream and atmospheric pollution should
be of active concern to physicians in private practice and in public health.
In one week in December, 1952, the London smog accounted for more excess
mortality, even in proportion to the population, than during any week of
the great cholera epidemic of 1866.
Our state is fortunate in that we have an alert medical profession well
represented on the state and local boards of health. We are one of the few
states with full coverage by sound local health departments. We have made
a beginning in cardiovascular disease diagnostic work. We have a good
start in finding cancer in the early stages when, in many cases, something
can be done to control it—provided the diagnostic efforts are not diverted
too obviously into estimating the size of the pocketbook before proceeding
with a medical diagnosis. Harnett County has an excellent program of
diabetes case-finding and supervision and physicians throughout the state
have cooperated in the annual week of diabetes case-finding. Cumberland
County has started an obesity control service. Halifax, Harnett and some
of the other counties have had limited experience in multiple screening
technics. The mental health services have expanded recently along lines
similar to the tuberculosis control work for early case-finding, guidance
and then post-hospitalization follow-up to prevent a breakdown. The nutri-tion
service has been strengthened. A recent grant by the Kellogg Foun-dation
has enabled the beginning of an intensive program in control of
home and farm accidents. A cooperative program with the Motor Vehicle
Bureau has been stimulated by Cornell University consultants in a study
of motor vehicle design as it may contribute to, or tend to prevent, serious
crash injuries. Some progress in the treatment of arthritis, atherosclerosis
and bursitis has been made and there is increasing hope of improvement in
our knowledge regarding their prevention.
North Carolina Board of Health 43
The Rural Health and Public Relations Committees have contributed in
a fundamental way in laying the groundwork for a better understanding
of, and a willingness and desire to proceed against, chronic disorders, and
accidents—just as was the case in earlier improved control of communica-ble
diseases. The work of the private practitioner will be just as ethical and
much more satisfying as all chronic disorders are promptly diagnosed and
control efforts are increased in effectiveness. Our state is in a strategic
position to lead the way in combating chronic disorders and accidents just
as private practitioners and the public health team joined hands to pioneer
in communicable disease control.
(For synopsis of departmental reports see THE HEALTH BULLETIN, issue June. 1955.1
44 Thirty-Sixth Biennial Report
STATE AND LOCAL HEALTH DEPARTMENT
SERVICES IN NORTH CAROLINA *
By J. W. R. Norton, M.D., M.P.H., F.A.C.P.**
Raleigh
Since so many know only part of the services of the state and local
health departments it seems appropriate to outline these so that we may
have more informed medical guidance in future program planning.
The state and local health departments in North Carolina have enjoyed a
growth in quality and quantity comparable to that of general hospitals
and private practice during the same period. This medical society was in
1877 and for two years the State Board of Health with an annual appro-priation
of $100.00 In 1879 a Board of nine, similar to that of today, was
set up. It was twenty-nine years later that a full-time physician was
employed. The fumigation, quarantine and the regulation-enforcement
emphasis era were as unsatisfactory in prevention as the similar groping
progress in private practice of the same period were in treatment.
The nine-member State Board of Health (five appointed by the Gov-ernor
and four by this Medical Society—six of these physicians) with
staggered four-year terms, formulate policies and prescribe regulations
and procedures that are carried out administratively through the 300 central
staff and 1200 local department employees.
The central staff organization is set up under the State Health Officer
and Assistant State Health Officer with six Division Directors and about
thirty section chiefs. The bare listing of titles suggests the programs and
services.
1. Central Administration includes budget, personnel, files, printing,
mailing and public relations.
2. The Epidemiology Division embraces sections as follows:—acute com-municable
diseases, public health statistics, venereal diseases, tuber-culosis,
occupational health, home and farm accident prevention, and
veterinary public health. Epidemiological consultations are increasing
in frequency and usefulness.
3. The Laboratory Division protects the public health through services
to private physicians, hospitals and health departments, through
biologies, microscopy, cultures, serology, water analyses, chemistry,
and approval of laboratories. The growing library should be of in-creasing
helpfulness to health staffs and private physicians.
4. The Local Health Division has sections as follows:—administrative,
public health nursing, mental health, health education, and (jointly
with the Education Department) school health.
5. The Oral Hygiene Division provides education through visual media,
lectures and literature and also services in consultation, correction
and prevention.
* Presented during Conjoint Session—Medical Society of North Carolina and Slate Board
of Health, Pinehurst. 2 May, 1956.
** Secretary-Treasurer of the State Board of Health and State Health Officer.
North Carolina Board of Health 45
G. The Personal Health Division includes the maternal and child health,
crippled children, nutrition, cancer, and heart disease sections.
7. The Sanitary Engineering Division includes four sections: sanitation,
(environmental, public eating places, milk, and shellfish), engineering,
insect and rodent control, and stream sanitation. Radio-active wastes,
air and stream sanitation and housing are of increasing importance.
Local health departments began in 1911, under the leadership of North
Carolina's first full-time health officer, Dr. Watson S. Rankin, and reached
the entire State in July, 1949. From the beginning there has been local
autonomy, flexibility and adaptability and medical guidance. Strong local
boards actively supported by the county medical society and public have
assured progressively better health services.
From the minimum of a health officer, public health nurse, sanitarian
and clerk (each full-time) and a ten-week oral hygiene program to a
large department such as Mecklenburg's (with about 150 workers, including
a full-time dentist) the services are provided mainly on the economical
generalized basis.
Local health department services may be briefly described under seven
headings:
1. Sanitation—The utmost in tact and leadership are required to assux-e
clean drinking water and milk and safe disposal of human wastes,
safe food processing and vending establishments and healthful schools
and camps. More should be done to protect our streams and the air
from contamination and to promote better housing for all, including
migratory farm laborers. Certain insects and rodents have depleted
food, clothing and shelter and spread epidemics and the health depart-ment
team wages war on those harmful to us. The approach is through
education and helpful leadership rather than authoritarian.
t/2. Good maternal-child hygiene begins with planned parenthood and
extends through prenatal, natal (including midwife supervision), post-natal,
infant, pre-school and school periods. Nutrition and oral hygiene
services are essential. Crippled childrens' services and rehabilitation
restore many to useful, happy lives. In this area we have reached
the best development as a cooperating team of private physicians,
hospitals and the public health staff and always including research and
teaching. Research indicates that a constructive maternal-child health
program will definitely reduce the incidence of mental defectives, juve-nile
delinquency and possibly some of the later neuroses, psychoses and
degenerative diseases. This is not too far back to go in planning a
preventive program in gerontology.
3. Communicable disease control is dependent on sanitation activities,
immunizations wherever available, and as in all other health progress
the cooperation between the public health team and the private prac-titioner-
hospital team is essential. Progress against the diarrheas,
dysenteries, smallpox, typhoid, tuberculosis, diphtheria, and malaria
shows what this coordinated effort can accomplish. Health workers
have had an important role in improving the treatment methods in
/
46 Thirty-Sixth Biennial Report
tuberculosis and venereal diseases and as a result many of these can
now be better treated in doctor's offices.
4. Laboratory services of the local health department assist in the clinic
programs and also aid the private physician. Prompt diagnostic aid
in commoner communicable diseases and in milk examinations are
examples.
Health education is the job of the entire staff under the stimulation
and leadership of those with special training in this field. All individual,
group, and mass audio-visual and other media are useful. The nurse
or sanitarian can give detailed instruction to supplement the brief
visits with, and to, the family physician. The health department can
inform the public regarding quackery and faddists and encourage
early supervision by the competent and ethical medical practitioner.
6. Public health statistics constitute the inventory, the income and the
outgo, of human resources. They may explain losses and point the
way to gains. They assist the private practitioner by alerting him in
diagnoses and point the way for teamwork in recognizing and com-batting
enemies of health and life. Sound evaluation and program
planning are impossible without accui'ate health bookkeeping.
7. Chronic diseases, mental disorders and accidents can be attacked
jointly by those in research and teaching, health departments and
private practitioners by the same methods proved useful before
against former common communicable diseases. Diseases of the heart
and blood vessels, cancer, mental disorders and accidents, are increasing
in our aging and hurried population. We have much to learn regarding
the etiology of mental disorders and the chronic degenerative diseases.
We have reason to believe early case-finding and medical guidance
with nurse follow-up can be useful in most cases. What part is played
by nutrition, endocrinology or viruses we hope to learn more about
soon. Health statistics are useful in identifying problems in these
areas and health departments can inform the public on the necessity
to cooperate in prevention and treatment.
Services of local and state health departments are so intertwined that
it may become difficult to distinguish them. Wherever direct services or
specialist consultation are not feasible through the local health depart-ment,
the state provides them.
Services of local health departments are recognized as the most impor-tant,
but any large business requires a reasonable overhead guiding and
cohesive force. Hence central administration, public health statistics and
laboratory services. Most local department personnel serve on a gener-alized
basis and, therefore, the state provides a few state or district
specialist consultants in such fields as sanitary engineering, nutrition,
laboratory activities, public health nursing and epidemiology. Direct
services to local health departments and private physicians are provided
in maternal and child health, crippled children, laboratory examinations
and supplying of biological products, oral hygiene, tuberculosis and ve-nereal
disease case-finding, accident (home and farm) prevention, and
North Carolina Board of Health 47
health education. Private physicians are also served through laboratory
aids, epidemiological consultation and statistical services and study com-mittees
of this Society through statistical, epidemologcal, and other serv-ces.
Many consultative health services are provided other state agencies
and institutions such as sanitary engineering, nutrition and food service
with the Medical Care Commission, Prison Department, Tuberculosis and
Mental Hospitals, and Training Schools. Consultation is provided munici-palities
regarding design and construction of water treatment and sewage
disposal plants. Materials used in the manufacture of bedding are inspected.
Insect and rodent control assists municipalities and industries. Occupa-tional
health activities protect workers and promote industrial develop-ment.
Veterinary public health services (working closely with the Agri-culture
Department) help control diseases which primarily attack animals
but secondarily man, and stimulate the livestock industry. Oral hygiene
has far-reaching effects in maternal and child health, reduces absenteeism
and probably reduces the degenerative diseases of our aging population.
Mental health services are being developed along lines similar to our
tuberculosis control work; namely, some central or district assistance in
case-finding and consultation and local health department instructional
guidance and follow-up. Public health has played a key part in the only
considerable reduction of mental disorders, in paresis and pellagra.
These many services provided by the state and local health departments
are helpful to all our four and a half million citizens and enhance the
attractiveness of private practice throughout our state. By preventing
disability and postponing death the standard of living is raised. The private
physician or dentist can be called earier when illness or injury does occur,
if the family has not previously been handicapped by preventable dis-abilities.
Agriculture and industry are stimulated and tourists are attracted
to come and to return. The people are becoming better informed on what
they may reasonably expect in prevention, diagnosis, treatment and re-habilitation
and if any area is neglected the public relations of every
physician and of organized medicine suffer accordingly.
The cost of these public health services is amazingly low. From a total
expenditure for fiscal 1955 of $8,007,917.44, or less than $2.00 per capita,
seventy per cent ($5,623,263.32) was used by local health departments.
Much of the remainder was invested in direct services or in consultation
services to local health departments, to other agencies and institutions
(state and local) and to private physicians and hospitals. For clinic and
corrective services private physicians were paid $240,202.78, and hospitals
received $548,253.42. Yet the per capita cost of local health services was
$1,385 with county-city appropriations providing 75%, and for state health
department services, the cost was $.587. The continuation of this ethical
teamwork of a sound and balanced preventive service, with emphasis on
economical decentralization, joined with progressive and unselfish private
practice offers our best promise of continuing our free enterprise system.
48 Thirty-Sixth Biennial Report
BIENNIAL REPORT
CENTRAL ADMINISTRATION
(July 1, 1954—June 30, 1956)
There were no important changes in the organization of the State Health
Department during the biennium beginning July 1, 1954, and ending June
30, 1956. Under the simplified form of organization which went into effect
February 1, 1950, the work of the Department continued to be carried on
smoothly and without any complications.
As the work in the Central Administration Division is carried on under
the direction of the Secretary and State Health Officer, the activities of
this Division are taken up first in this biennial report. Briefly, the following
Sections comprise the Central Administration Division: Budgets, Public
Relations, Central Files, Personnel, Mailing Room, Multilith, and Library.
Hence, the Secretary and State Health Officer not only is the executive
head of the State Health Department but a Division Director to whom the
Chiefs of the above named Sections are answerable. His office involves not
only executive and administrative duties, but also responsibilities of a
liaison nature. He maintains contact with other State Health Departments,
certain other agencies within the State, and with many officials engaged
in various activities which have any Public Health aspects. This means
that the work of the Secretary and State Health Officer has expanded
considerably during recent years, in which there are arisen a multiplicity
of voluntary agencies which concern themselves, either wholly or in part,
with health. It is the duty of the Secretary and State Health Officer not
only to familiarize himself with the programs and objectives of these
agencies, but to study their relationship to Public Health officially admin-istered.
In this connection, candor compels the statement that, in some cases,
outside organizations have shown a tendency to duplicate some of the
activities which the law places in the hands of Public Health officials.
However, no really serious difficulties have been experienced because of
this. Public Health, during the past biennium, as in former years, has
continued to administer the affairs legally committed to its charge, ignor-ing
any minor infringements which may have appeared in the entire
pattern.
HEALTH OFFICER'S ACTIVITIES:
First, a brief summary of the activities of the Secretary and State
Health Officer during the period covered in this report. He has been active
in his participation in the affairs of those organizations and groups with
which the North Carolina State Board of Health is affiliated. Under the
law